Preferred drug list An evidence-based pharmacy program that works for you What is the Moda Health Preferred Drug Program and preferred drug list? The Moda Health Preferred Drug Program is a pharmacy program that offers a choice of medications that are safe, effective treatments; and provides value to Moda Health members by saving them money on prescription medications. These medications are shown in our preferred drug list. How does the program work? This program uses a tiered copay system. Members and their doctors can choose between the value tier, select generic tier, preferred tier or brand tier medications. Each tier has a different copay amount and will depend on your benefit. Refer to your Member Handbook for specific tier and coverage information. Who makes decisions about medications on the preferred drug list? The list is developed and maintained by a group of doctors and pharmacists called the Pharmacy and Therapeutics Committee. The committee makes decisions based on information about the medication’s safety, effectiveness and associated clinical outcomes. Value tier Value medications include commonly prescribed medications used to treat chronic medical conditions and preserve health. Plans that do not include a value tier benefit will have medications categorized under this tier paid at the generic tier or preferred tier copay/coinsurance levels. Select generic tier Preferred tier Brand tier Generic medications are considered by physicians and pharmacists to be therapeutically the same as brand name alternatives and at the most favorable cost. Generic medications must contain the same active ingredient as their brand name counterparts and be identical in strength, dosage and format. The preferred tier includes brand and specialty brand name medications that have been reviewed by Moda Health and found to be clinically effective at a favorable cost when compared with other medications in the same category. This tier includes brand and specialty brand name medications that have been reviewed by Moda Health and found not to have a significant therapeutic advantage over their preferred tier counterparts. This benefit level may also include select brand medications that have been identified as favorable from a clinical and cost effective perspective. This tier may also include generic medications that have been found to have the same clinical outcomes as their more cost-effective generic counterparts in the same category. 2015.1 (10/1/2014). For prior effective dates, please contact Moda Health. Medications in this tier have the brand tier copay/coinsurance amount. If you request a brand name medication or your physician prescribes a brand name medication when a generic equivalent is available, you may be responsible for the brand copayment plus the difference in cost between the generic and the brand name medication. Please refer to your pharmacy benefits outlined in your Member Handbook. Key How to read your preferred drug list Refer to your Member Handbook to find specific covered medications and copay amounts. Medications that are new to the market are not included within your prescription medication benefit until reviewed by the Pharmacy and Therapeutics Committee. Please contact us if you are taking a medication that is new to the market. V – Value tier copay SG – Generic tier copay P – Preferred tier copay For more information about our Preferred Drug Program and other medications that require clinical review, visit modahealth.com or call us toll-free at 503-243-3960 or 888361-1610. Medication name V SG P B ABILIFY ACETAMINOPHENCODEINE ACTIVELLA ACTONEL ACTOPLUS MET ACYCLOVIR ACZONE ADAPALENE ADVAIR HFA AGGRENOX ALENDRONATE ALLOPURINOL P B CEPHALEXIN ASTEPRO CIPRODEX ATENOLOL ATRIPLA ATROVENT HFA CITALOPRAM AVODART AZASITE BACTROBAN BENICAR BENICAR HCT BEYAZ ALREX AMITIZA BUDESONIDE EC BYETTA AMLODIPINE BESYLATE BYSTOLIC CADUET AMOXICILLIN AMPHETAMINE SALT COMBO CANDESARTAN CANDESARTANHCTZ CARVEDIOLOL ANDROGEL ARMOUR THYROID CANASA CEFDINIR CELEBREX 2015.1 (10/1/2014). For prior effective dates, please contact Moda Health. B CLONAZEPAM CLOPIDOGREL COLCRYS COMBIGAN COMBIPATCH COMBIVENT COREG CR CRESTOR CYCLOBENZAPRINE DEXILANT AMITRIPTYLINE HCL P CIPROFLOXACIN HCL ATORVASTATIN V SG CENESTIN BISOPROLOL FUMARATE-HCTZ AMOX TRPOTASSIUM CLAVULANATE Medication name ASMANEX AZITHROMYCIN ADVAIR DISKUS V SG ASACOL HD ACANYA Medication name B – Brand tier copay DEXMETHYLPHENI DATE ER DIAZEPAM DIFFERIN DIOVAN DUAC CS DULOXETINE EFFIENT ELIDEL ELMIRON ENABLEX Medication name V SG ENALAPRIL ENALAPRIL-HCTZ P B Medication name B Medication name JANUVIA MOXIFLOXACIN KADIAN NAPROXEN ENJUVIA LAMOTRIGINE EPIDUO LANTUS EPIPEN LANTUS SOLOSTAR EPIPEN JR LATANOPROST V SG P V SG NASONEX NEXIUM NIASPAN LEVEMIR ESTRADIOL LEVOFLOXACIN NOVOLIN N LEVOTHYROXINE SODIUM NOVOLOG ESZOPICLONE EVISTA EXFORGE FEMHRT FEMRING FINACEA FLOVENT HFA FLUCONAZOLE FLUOXETINE HCL FUROSEMIDE GLIPIZIDE HUMALOG HUMULIN N HUMULIN R HYDROCHLOROTHI AZIDE LISINOPRIL-HCTZ LOSARTAN POTASSIUM NUCYNTA NUVIGIL OLANZAPINE OMEPRAZOLE OMNARIS ONGLYZA OXYCODONE HCL OXYCODONEACETAMINOPHEN LUMIGAN OXYCONTIN LYBREL OXYMORPHONE ER LYRICA MALARONE PANTOPRAZOLE SODIUM PAROXETINE HCL METFORMIN HCL METFORMIN HCL ER PATANOL PENICILLIN V POTASSIUM METHYLPHENIDATE CD PATADAY PENTASA PIOGLITAZONE POTASSIUM CHLORIDE METOPROLOL TARTRATE PRAVASTATIN SODIUM PREDNISONE METROGEL METRONIDAZOLE INTUNIV MONTELUKAST IRBESARTAN-HCTZ MORPHINE SULFATE ER MODAFINIL IRBESARTAN JANUMET LORAZEPAM NITROSTAT METOPROLOL SUCCINATE IBANDRONATE IBUPROFEN MENEST GLUCAGON EMERGENCY KIT GLYBURIDE LIDODERM LOVASTATIN GABAPENTIN LOTEMAX FLUTICASONE PROPIONATE NASAL SPRAY LIALDA LISINOPRIL MOVIPREP 2015.1 (10/1/2014). For prior effective dates, please contact Moda Health. B NASACORT AQ ESCITALOPRAM ESTRING P PREMARIN TABLETS PREMPRO PREVIDENT PRISTIQ Medication name V SG P PROAIR HFA B Medication name SPIRIVA SPIRONOLACTONE PROMETHAZINE HCL PROTOPIC SULFAMETHOXAZO LE-TRIMETHOPRIM PROVIGIL SUPREP SYMBICORT PULMICORT FLEXHALER RABEPRAZOLE RALOXIFENE RELPAX RHINOCORT AQUA RIZATRIPTAN RIZATRIPTAN ODT SAVELLA SEROQUEL XR SIMCOR SIMVASTATIN SINGULAIR P TAZORAC TELMISARTAN TELMISARTANHCTZ TOLTERODINE TOLTERODINE ER VENTOLIN HFA VERAMYST VESICARE VICTOZA VOLTAREN TOPICAL VYTORIN VYVANSE TRANSDERM-SCOP VALSARTAN-HCTZ VIVELLE-DOT TRIAMTERENEHCTZ VIIBRYD TRAVATAN Z VIGAMOX TRAZODONE HCL VALSARTAN B VAGIFEM VALACYCLOVIR TRICOR TRILIPIX 2015.1 (10/1/2014). For prior effective dates, please contact Moda Health. V SG UROXATRAL TAMIFLU TRAMADOL HCL Medication name TRUVADA SYNTHROID QUETIAPINE FUMARATE B SUBOXONE FILM PROVENTIL HFA SERTRALINE HCL P STRATTERA PROMETRIUM QVAR V SG WARFARIN SODIUM XOPENEX HFA ZETIA ZOLMITRIPTAN ZOLMITRIPTAN ODT ZYMAR Common questions and answers What makes the Moda Health Preferred Drug Program different? The Moda Health Preferred Drug Program works differently than a typical drug formulary. Many formularies require you to use the generic or low-cost brand medications listed on their formulary and will not pay for any high-cost medications not on that list. Moda Health offers more flexibility; members can choose highcost medications if they wish and still have a portion of the costs paid by Moda Health. Does the tiered drug program limit which medications my doctor can prescribe for me? This list is not meant to replace a doctor’s judgment for prescribing decisions. The Moda Health Preferred Drug Program is designed to offer cost-effective choices that will save members money on prescription medications. Moda Health does not take responsibility for any medication decisions made by the prescriber or dispensing pharmacist. What if my prescribed medication is not on the preferred drug list? The Moda Health preferred drug list is not all-inclusive. To check your copay for medication not on this list, please use the online price check tool available through your myModa account under the Pharmacy tab. If you are taking a medication that is new to the market, please contact Moda Health Customer Service to learn its coverage and its tier level. How are diabetic supplies covered? Please check your Member Handbook for specific coverage of diabetic supplies. Abbott and Bayer diabetic supplies are the Moda Health preferred tier products. In addition, a free blood glucose meter is available for the preferred meters (Abbott or Bayer). For more information about this program please call Moda Health Pharmacy Customer Service. How can I find out how much my medication will cost? Moda Health provides an online drug price check tool for members. You can access this resource by logging in to your myModa account at modahealth.com. The price check tool is located under the Pharmacy tab. How do I use my mail-order benefits? When is the preferred drug list updated and how are members notified? Changes to the list reflecting new medications or changes in treatment patterns will be made throughout the year. Members are notified by letter if the change will have a negative impact (higher copayment, etc.). To see the current list, visit modahealth.com, choose the Member tab and click Resources. When a generic becomes available for a brand name medication, the brand name medication will be moved to the brand tier. If you receive a brand name medication when a generic is available, you may pay the difference between the brand name and generic medication in addition to your copayment. For more information, please log in to myModa at modahealth.com and review your Member Handbook. Members have the option of obtaining a 90-day supply per prescription through our mail-order pharmacy. To find links to our mailorder forms, visit modahealth.com, choose the Member tab and click Resources. Please refer to your Member Handbook for copayment information. Copyright © 2014 Moda, Inc. All Rights Reserved. Health plans in Oregon, Alaska and Washington provided by Moda Health Plan, Inc. Health plans in Califor nia provided by Moda Health Plan, Inc. dba Moda Health Insurance. Dental insurance products in Oregon provided by Oregon Dental Ser vice. Dental insurance products in Alaska provided by Delta Dental of Alaska.Alaska provided by Oregon Dental Service doing business as Delta Dental of Alaska. 2015.1 (10/1/2014). For prior effective dates, please contact Moda Health.
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