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PEBB Specialty Pharmacy FAQs

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

Yes. Specialty medications must be accessed through the exclusive specialty pharmacy. These prescriptions may be limited to a 31-day supply and require prior authorization. Members can get a list of medications and information about their plan coverage and their out-of-pocket costs by selecting the “Pharmacy” tab in their Member Dashboard. They can also call our Health Navigators at 844-776-1594..

What are specialty medications?

Specialty medications are often prescribed to treat complex chronic health conditions. They require special handling techniques, careful administration and an individualized ordering process. Details about our clinical services and a list of specialty medications can be accessed on the PEBB-specific Moda Health website, through the Member Dashboard, or by contacting our Health Navigators at 844-776-1594.

Any new specialty drug approved by the Food and Drug Administration (FDA) is not covered until approved by Moda Health.

How do I get started with the exclusive specialty pharmacy?

Ardon Health specialty pharmacy is the exclusive specialty pharmacy for PEBB members with Moda Health plans. Ardon Health can enroll you into our program over the phone, by contacting your physician for prescription information or by transferring an existing prescription from another pharmacy. To get started, contact your Health Navigator at 844-776-1594.

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

If you may run out of your specialty medication before you can get set up with the exclusive specialty pharmacy, please call your Health Navigator at 844-776-1594. They will work closely with you, your provider and the exclusive specialty pharmacy to get you the medication before you run out.

What if I can't afford my specialty copay?

The exclusive specialty pharmacy will research financial assistance programs to see if there is any support available for you. If they find a program, the Health Navigator will work with you to apply for financial assistance.

How can I pay for my specialty prescription order?

When you schedule your order, you can pay by credit card, debit card or check. ALL payments must be made before the product is shipped.

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 it to ensure it is delivered on the date the order is requested to be received.

The specialty pharmacy will also ship, with your order, any additional supplies you may need in order to administer your medication, such as syringes, alcohol swabs and sharps containers.

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. However, with our specialty lite program, you may receive 90-day supply for certain specialty medications.

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

However, there are some specialty medications that may not require such limitation and can receive 90- day supply for certain specialty medications.

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