Formulary

Our formulary is our list of covered prescription drugs to see what generic and brand-name drugs are covered under our plans that have prescription drug coverage. Please note this formulary may change. Please see our formulary updates section below to view changes. If you do not see the drug you are looking for in the formulary, please call our pharmacy customer service (number listed below). We may cover that drug. You can also contact pharmacy customer service to request a printed copy of the formulary.

View our Formulary

2024 Moda Medicare Advantage Formulary
2023 Moda Medicare Advantage Formulary

Search the online benefit tool for prescription drugs*

With this tool you can:

  • Search for a drug to see if it’s covered,
  • Get a prescription drug cost estimate,
  • See there is an alternative drug available,
  • Find the price and location of pharmacies near you,
  • Check the price or option for mail order.

If you’re a current Moda Medicare Advantage member, please access the online benefit tool for prescription drugs through your Moda Member Dashboard for a more accurate cost estimate that accounts for your personal claims.

Follow these steps to use the online tool

  1. Select one of the plan names, below
    • A new window will open with the online benefit tool for prescription drugs

  2. Enter a drug name

  3. Provide the quantity and the number of days

  4. Enter your ZIP code

Select your plan to start the online tool

2024 plans

Moda Health Central PPORX (PPO)
Moda Health Elements PPORX (PPO)
Moda Health + Fred Meyer PPORX (PPO)
Moda Health Metro PPORX (PPO)
Moda Health Mid-valley PPORX (PPO)
Moda + PeaceHealth PPORX (PPO)
Moda Health Southern PPORX (PPO)
Moda Health Value PPORX (PPO)

2023 plans

Moda Health Central PPORX (PPO)
Moda Health + Fred Meyer PPORX (PPO)
Moda Health Metro PPORX (PPO)
Moda Health Mid-valley PPORX (PPO)
Moda Health NW PPORX (PPO)
Moda Health Southern PPORX (PPO)
Moda Health Value PPORX (PPO)

*Prescription drug information displayed on the online benefit tool is subject to change without notice and is not a guarantee of benefits. Your coverage is based on your plan benefit and eligibility at the time of service. If you have copay assistance it may affect your deductible and/or your maximum out of pocket amount. Coverage and cost sharing may vary for preventive service.

Preferred diabetic devices and supplies 

Moda Health covers the following preferred diabetic devices and supplies. 

Please refer to your Evidence of Coverage (EOC) for your benefits and plan rules.

Device/supply** ; Preferred manufacturer
Continuous Glucose Monitor (CGM) Dexcom
Abbott
Test strips/meter Acensia
Abbott

**Diabetic devices and supplies are covered through your Part B (medical) Medicare benefits. There may be prior authorization requirements and quantity limits. “Preferred” products do not guarantee coverage. We will not cover other brands and manufacturers for Part B diabetic devices and supplies unless your provider tells us that a different brand is appropriate for your medical needs. However, if you are new to our plan and are using a different brand, we will continue to cover that brand for you for up to 90 days. During this time, you should talk with your doctor to decide what brand is medically appropriate for you after the 90-day period.

Pharmacy customer service

Please call our Moda Health Pharmacy Customer Service team at 888-786-7509. TTY users, dial 711. Pharmacy Customer Service is available from 7 a.m. to 8 p.m., Pacific Time, seven days a week from October 1 through March 31. After March 31, your call will be handled by our automated phone system on Saturdays, Sundays and holidays.

Formulary updates

We may make changes to the formulary. Changes include:
  • Adding or removing drugs. This happens if a drug is recalled or not working, or a new drug becomes available
  • Moving a drug to a higher or lower cost-sharing tier
  • Adding or removing a restriction on coverage
  • Replacing a brand-name drug with a generic drug

If we make changes to a drug you are taking, we will send you a notice.

Making an exception

We may be able to cover a drug for you if you ask us to make an exception. You can request an exception if:

  • Your Part D-eligible drug is not on our formulary
  • We ask you to try another drug before you receive a drug you have requested
  • We limit the quantity or dose of a drug you have requested

To request an exception, you or your provider may do one of the following:

Last updated Oct. 1, 2023
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