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Pharmacy FAQs

How do I find out how a medication is covered under a prospective plan?

Moda Health offers a variety of plan options and benefits designs. Please contact your Sales & Account Service Representative to determine how a medication may be covered.

Does Moda Health partner with a mail-order pharmacy?

Yes, Moda Health partners with exclusive mail-order pharmacies to offer members a 90-day supply delivered directly to a U.S. address of their choice. The participating mail-order pharmacy will depend upon the pharmacy network that the plan's benefits are under. To determine a plan's mail-order pharmacy, refer to the plan's benefit summary or call your Moda Health Sales & Account Service Representative.

What should a member do if they need to fill a prescription but do not have an ID card?

A pharmacy will need the member's unique Moda Health ID number, pharmacy BIN number, and pharmacy PCN number. The member and/or pharmacy may call Moda Health Pharmacy Customer Service to obtain the information necessary to process a claim.

Is the member required to access specialty medications (e.g., self-injectables, biologics, etc.) through an exclusive specialty pharmacy?

Yes, specialty medications must be accessed through the exclusive specialty pharmacy. The participating specialty pharmacy will depend upon the pharmacy network for the plan. To determine a plan's specialty pharmacy, refer to the plan’s benefit summary or call your Moda Health Sales & Account Service Representative.

Each specialty prescription is limited to a 30-day supply and will require prior authorization by Moda Health. A listing of specialty medications is available through the member’s myModa account.

What is the Northwest Prescription Drug Program, OPDP and WPDP?

The Oregon Prescription Drug Program (OPDP) joined the Washington Prescription Drug Program (WPDP) to combine purchasing power and formed the partnership “Northwest Prescription Drug Consortium”.

Through the OPDP and WPDP, individuals living in Oregon or Washington may obtain a free discount card offering savings of up to 60 percent on generic medications and up to 20 percent on brand medications.

Employer groups in Oregon and Washington can join the Northwest Prescription Drug Consortium and take advantage of the value of the Consortium’s purchasing strength, resulting in lower pharmacy plan costs. Groups can expect competitive market rates from pharmacies. No matter what size group, they will receive financially guaranteed performance standards that deliver true customer focused care. All Groups will receive transparency in contracting. Rebates, incentives and any form of manufacturer’s credits related to a group’s pharmacy experience will be passed directly to those groups. Auditable reporting will tie a group’s claims utilization to their rebate reporting. Transparency without verifiable reporting is not true transparency.

For more information, please contact your marketing representative.

Answers represent Moda Health standard benefits, for group specific details refer to your group's specific Member Handbook.

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Hello.

We have exciting news to share. ODS is changing its name to Moda Health.

Moda comes from the latin term "modus" and means "a way". We picked it because that's what we are here to do: help our communities find a way to better health.

Together, we can be more, be better.

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