Our network gives you choices for when and how you order prescription drugs. We contract with hundreds of pharmacies in Oregon and pharmacies throughout the U.S. Our network includes retail pharmacies, home infusion, long-term care, Indian health service pharmacies, and specialty and mail-order pharmacies. And, for your convenience, you can fill up to a 93-day supply of maintenance medications at your local retail pharmacy.
We cover prescriptions from in-network pharmacies. Unless you are in one of the circumstances we list below, we cannot cover prescriptions from out-of-network pharmacies. Circumstances for out-of-network prescription coverage:
- Medical emergencies
- If a pharmacy that is open 24 hours is not within a reasonable driving distance
- You cannot get the prescription you need because an in-network pharmacy does not have it in stock
- You are traveling outside your plan service area and run out of or lose your covered Part D drugs
- You become ill and need a covered Part D drug, and cannot access a network pharmacy
In these circumstances, we can fill up to a 31-day supply. If you are in one of these circumstances, please call us before you fill your prescription. We can see if there is a network pharmacy in your area. Please call our Moda Health Customer Service at 503-265-4709 or toll-free at 888-786-7509. TTY users, dial 711. Customer Service is available to help you from 7 a.m. to 8 p.m., Monday through Friday. Weekend calls are forwarded to voicemail and returned the next day.
If you do go to an out-of-network pharmacy, you may have to pay the full cost of the drug instead of just your copayment or coinsurance. You also may pay more for your prescription. You can ask us to reimburse you for this prescription by submitting a claim.
Pharmacy Customer ServicePlease call our Moda Health Customer Service at 503-265-4709 or toll-free at 888-786-7509. TTY users, dial 711. Customer Service is available to help you from 7 a.m. to 8 p.m., Monday through Friday. Weekend calls are forwarded to voicemail and returned the next day.
Last updated Sep. 26, 2018