Pharmacy

Preferred Drug List: A tiered copay system

The Preferred Drug Program uses a tiered copay system. You and your patients can choose between value tier, generic (tier 1), preferred (tier 2) or brand (tier 3) drugs. Each has a different copay amount that will depend on the member’s specific benefit. Those details can be found in your patient’s Member Handbook for specific tier and coverage information. You’ll find the Preferred Drug List (PDL) that applies to your patient by logging in to Benefit Tracker.

The PDL is developed and maintained by a committee of doctors and pharmacists who make decisions based on each drug’s safety, effectiveness and associated clinical outcomes.

Flexibility and choice

Members can choose high-cost drugs and still have a portion of the costs paid by Moda Health. Many other formularies require members to use the generic or low-cost brand drugs to receive any benefit. The Moda Health Preferred Drug Program is not meant to replace your judgment for prescribing decisions.*

The Moda Health Preferred Drug List is not all-inclusive. Generic drugs that do not appear on the list will be paid at the generic (tier 1) copay. Brand drugs that do not appear on the list and do not have less expensive brand or generic alternatives will be paid at the preferred (tier 2) copay. Drugs that are new to the market and not on the list will not be covered until reviewed by the Moda Health Pharmacy and Therapeutics Committee.

*Moda Health does not take responsibility for any drug decisions made by the prescriber or dispensing pharmacist.

Diabetic drugs and supplies

Abbott and Bayer diabetic supplies are the preferred (tier 2) products and include a free blood glucose meter.

When brand name is the preferred drug

If your patient requests a brand name drug or if you prescribe a brand name drug when a generic equivalent is available, the Moda Health member will be responsible for the brand copayment plus the difference in cost between the generic and the brand name drug.

Updates to the PDL

Modifications to the list reflecting new drugs or changes in treatment patterns are made throughout the year. When a generic becomes available for a brand name medication, the brand name drug will be moved to the Brand Tier (3).