Pharmacy

Why choose Moda Health

Moda Health has the right pharmacy benefits to meet your needs with wide networks, carefully crafted formularies, online tools for members and more.

Preferred drug program

This program uses tiers to provide the right prescriptions at the right prices. Your employees and their providers can choose between value, select, preferred, non-preferred, preferred specialty or non-preferred specialty tier drugs. Each tier has a different copay or coinsurance amount, based on your benefit.

Pharmacy benefits, and then some

Pharmacy networks

Based on your plan, employees have access to one of two pharmacy networks, the Navitus network or the Northwest Prescription Drug Consortium. Employees should use their member ID card to verify which network their plan uses.

Navitus network

The Navitus Network includes access to over 95% of pharmacies in Oregon, plus more than 58,000 pharmacies nationwide. This means your employees can fill prescriptions almost anywhere, including these local and national drug store chains:

• Costco
• CVS
• Fred Meyer
• Rite Aid
• Safeway and Albertsons
• Walgreens
• Walmart

Locate a pharmacy in the Navitus network >

Northwest Prescription Drug Consortium (MedImpact)

The Northwest Prescription Drug Consortium is supported by MedImpact, a Pharmacy Benefits Manager. MedImpact operates a robust pharmacy network in Oregon and across the nation that includes both independent pharmacies and national chains.

Locate a pharmacy in the MedImpact network >

Mail-order services

If your employees have chronic health conditions, our mail-order services may be for them. This program is open to members who require ongoing treatment for conditions like high blood pressure, asthma or diabetes.

If their plan allows, they can order up to a 90-day supply of medication. To get started, just visit Postal Prescription Services (PPS) online or call for more information.

Postal Prescription Services (PPS)
Members can contact Postal Prescription Services (PPS) at 800-552-6694 or visit the PPS website.

Health support, online

Member Dashboard

Members have access to the Member Dashboard, our personalized member website. Your employees will love everything they can do at Member Dashboard, including:

• Checking medication costs
• Viewing prescription history
• Finding in-network pharmacies
• Reviewing drug interactions

Members access their dashboard at modahealth.com/memberdashboard >

Formularies and medication tiers

Group plans using the Navitus pharmacy network

For group plans that use the Navitus Network, members can search our formulary to see medications by tier and coverage level.

• Prescription drug list for large group
• Value tier medications list
• Vaccines covered at the pharmacy
• Preferred diabetes supplies & insulins
• Summary of changes for small group members
• Summary of changes for large group members

Group plans using the Northwest Prescription Drug Consortium (MedImpact)

For group plans that use the Northwest Prescription Drug Consortium, members can explore our formulary lists to see medication tiers and coverage requirements:

• Prescription drug list
• Value tier medications list
• Vaccines covered at the pharmacy
• Preferred diabetes supplies & insulins
• Summary of changes

Questions?

If you’re shopping for pharmacy benefits

Call the Moda Health Sales and Account Service team  at 503-243-3948 or toll-free at 800-578-1402. Or, contact your producer.

If you want to know about your plan

To learn more about Moda Health pharmacy benefits, including formularies and medication tiers, please contact Moda Health Pharmacy Customer Service  at 503-243-3960 or toll-free at 888-361-1610. Members can also access this information by visiting the Member Dashboard.