Disclaimers

• See plan design for plan specific day supply allowances. 90-day supply available through participating mail-order pharmacies on all tiers except Specialty Tier.
• Tiering of brand medications may change when generic medications become available. Scheduled updates to the formulary and tiering placement occur throughout the year. This reflects tiering as of the date of the search.
• The benefits listed apply to network pharmacies' contracted rates which are generally lower than non-member rates.
• Please consult your prescriber to discuss similar drugs, therapeutically equivalent dosages, potential side effects and risks, and applicability for your condition.
• Moda does not prescribe or dispense medications, drug selection rests solely with the prescriber.