FormularyUse our 2021 formulary (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 to view changes. If you do not see the drug you are looking for in the formulary, please call our pharmacy customer service. We may cover that drug. You can also contact pharmacy customer service to request a printed copy of the formulary.
Please call our Moda Health Pharmacy Customer Service at 503-265-4709 or toll-free 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 Saturdays, Sundays and holidays.)
Formulary updatesWe 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
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:
- Complete our online coverage determination and exception request (members and providers)
- Contact Moda Health Pharmacy Customer Service at 888-786-7509. TTY users, dial 711.
- Mail your request by completing this coverage determination and exception request form .
Last updated Oct. 9, 2020