OEBB OPDP

Specialty Pharmacy Benefits

Are OEBB members required to access specialty medications (e.g., self-injectables, biologics, various other medications, etc.) through an exclusive specialty pharmacy?

Yes. Specialty medications must be accessed through the exclusive specialty pharmacy. These prescriptions are limited to a 31-day supply and require prior authorization. Members can obtain a list of eligible medications and get information on the tiering of their medication by clicking the pharmacy tab in their myModa account or by calling Moda Health Pharmacy Customer Service at 866-923-0411.

Moda Health has partnered with Ardon Health Specialty Pharmacy (Ardon) to provide specialty pharmacy services to OEBB members. If you would like to begin the enrollment process or update your content information, please contact Ardon customer service at 855-425-4085.

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What are specialty medications?

Specialty medications are often prescribed to treat complex chronic health conditions. Respecting that specialty treatments often require special handling techniques, careful administration and a unique ordering process, enhanced member services are provided by the Plan. Information about our clinical services and a list of eligible specialty medications can be accessed online at www.modahealth.com/oebb, through your myModa account or by contacting Moda Health Pharmacy Customer Service at 503-265-2911 or toll free at 1-866-923-0411.

Medications given intravenously are typically not considered to be specialty medications. Any new drug approved by the FDA after the date this policy goes into effect is not covered until approved by Moda Health.

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What medications are eligible for the enhanced specialty program?

Your OEBB pharmacy benefit provides enrollees prescribed specialty medications, access to enhanced clinical services and an exclusive specialty pharmacy. Certain prescription drugs or medicines, including most self injectables and other injectable drugs (e.g., Enbrel, Copaxone, Avonex), must be purchased through the exclusive specialty pharmacy to be a covered benefit.

A list of the current specialty medications eligible for this program is posted online at www.modahealth.com/oebb, through your myModa account. The exclusive specialty pharmacy will also ship, with your order, any additional supplies that you may need in order to administer your medication such as syringes, alcohol swabs and sharps containers.

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How do I get started with the exclusive specialty pharmacy?

The exclusive specialty pharmacy can enroll you into our program over the phone and contact your physician for the prescription information or transfer an existing prescription(s) from your retail pharmacy.

Ardon Specialty Pharmacy is the exclusive specialty pharmacy through Moda Health. If you would like to begin the enrollment process or update your content information, please contact Ardon customer service at 855-425-4085.

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What can I do if I am unable to fill my prescription before I run out of medication?

If you are concerned that you may run out of your specialty medication before you can get set-up with the exclusive specialty pharmacy, please call Moda Health pharmacy customer service at 866-923-0411. The customer service representative will work closely with you, your provider, and the exclusive specialty pharmacy to get you the medication before you run out.

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What if I can’t afford my specialty copay?

The exclusive specialty pharmacy will research available financial assistance programs to see if there is any support available to you. If a program is identified, they will coordinate assistance with you (the patient). If there is no available assistance then you (the patient) will need to decide how to proceed and if you want to continue the prescribed therapy.

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How can I pay for my specialty prescription order?

When you schedule your order, payment can be made with a credit card. ALL payments must be made in advance and prior to the product being shipped.

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How will my specialty order be shipped?

If your medication is refrigerated, your order will be shipped via overnight delivery in special packaging to ensure the product remains refrigerated. If your medication does not require refrigeration, the exclusive specialty pharmacy will ship to ensure it is delivered on the date the order is requested to be received.

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How much of my specialty medication will be shipped to me each time?

Your benefit authorizes up to a 31 day supply of specialty medications.

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Why am I limited to a 31 day supply for my specialty medication?

The Moda Health Specialty Drug Program provides payment for a 31-day supply of specialty medications to avoid waste resulting from abrupt discontinuation. A medication can be discontinued for many reasons, including:

  • Intolerable side effects
  • Less-than-ideal results from the medication
  • Dangerous changes in laboratory results

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