Questions and Answers. When should I use mail order pharmacy services? What is my co payment for drugs? What is my co payment for preferr

Transcription

1 WPDP/Moda Health Pharmacy Program Welcome to your new pharmacy program, offered through the Washington Prescription Drug Program (WPDP) and administered by Moda Health, formerly ODS Health. At Moda Health, we re passionate about helping you find a way to be better. To ensure a smooth transition to Moda Health, we put together these questions and answers. Please review them to learn more about your Moda Health prescription drug benefits. Thank you again for joining us. We look forward to supporting your health, every step of the way. Questions and Answers How do I set up mymoda account? How do I find a pharmacy? When should I use mail order pharmacy services? Are specialty pharmacy services covered? Can I call WPDP/Moda Health Pharmacy Customer Service? What is a generic drug? Is a generic drug the same as a brandname drug? Who makes generic drugs? Why use a generic drug? What is my co payment for drugs? What is my co payment for preferr What should I ask my doctor regarding prescribed medications? What are quantity limitations? Why are prior authorizations required? What if I'm told the pharmacy cannot fill my prescription? How do I set up mymoda account? As a Moda Health member, you also have access to mymoda (formerly myods), your personalized member website. This tool is one of the most innovative and knowledgeable pharmacy benefit managers in the industry. You ll find valuable tools and easy to use features designed to help you navigate your benefits and lower your costs. To log in for the first time, simply go to modahealth.com and click on mymoda. Then create your account by following the instructions. Be sure to have your Moda Health ID card handy. Once your new mymoda account is all set, you can: Access the formulary: Research covered and preferred medication options along with clinical review and prior authorization requirements. Compare costs: Discover whether there are potential lower cost options available under

2 your plan that could save you money. Manage your meds: Keep track of your prescriptions, order refills through your specialty and mail order providers, and monitor how much you have spent on medications for the year. Ask a question: Contact pharmacy customer service to answer your prescription drug questions. Check your coverage: Look up your plan s coverage to be an informed health care consumer. Download a form: Obtain claim forms, order forms and additional fax forms. How do I find a pharmacy? You can go online to locate a participating retail pharmacy near your home or work. To find an innetwork pharmacy, or to check if your current pharmacy is in network, please visit modahealth.com and click on Find Care. This interactive tool allows you to search for physicians, pharmacies and clinics by location, gender or language spoken. You can also search for pharmacies within the NW Prescription Drug Consortium network using Find Care. Simply enter your member ID so that all your results will be catered to your specific plan (your member ID can be found on your Premera Health ID card). Please note that Walgreens is not currently participating under the NW Prescription Drug Consortium network. If you are currently using Walgreens, use Find Care to locate a convenient alternative pharmacy by searching through the more than 600 participating pharmacies in Oregon, and more than 49,000 nationwide. When should I use mail order pharmacy services? It s often more convenient to purchase prescriptions for ongoing conditions like diabetes, high blood pressure and high cholesterol through Postal Prescription Service (PPS) mail order pharmacy instead of a retail pharmacy. Located in Portland, Oregon, PPS is a full service mail order pharmacy providing exceptional service and clinical expertise to its customers. There are many benefits in using PPS mail order pharmacy: Up to 90 day supplies delivered right to your door, with free standard shipping Multiple safety and advanced quality checks to ensure you get the right medication 24 hour phone support from a pharmacist To use PPS, please make sure you: Contact your doctor and request a new prescription for up to a 90 day supply of each

3 medication. Generally, a doctor s visit is not required to write a prescription for a medication you already take. Mail the new prescription(s) (no photocopies) to PPS along with a completed order form. Ask your provider to fax the prescription to PPS after you ve registered with PPS. To register with PPS, call or download a registration form at ppsrx.com. Mail your completed form to PPS. If you would like to transfer your current mail order prescriptions to PPS, please contact them at the phone number below. PPS will work with your current mail order pharmacy and/or your physician to transfer your existing prescription. PPS Customer Service: Hours: Monday Friday, 6:00 a.m. 6:00 p.m. PT; Saturday, 9:00 a.m. 2:00 p.m. PT Please don t forget to reorder before your run out of your medication. It is important to allow 7 to 10 business days for shipping once your order has been placed. Are specialty pharmacy services covered? Your pharmacy program provides access to Diplomat Specialty Pharmacy, the exclusive specialty medication provider for your plan. Diplomat Specialty Pharmacy offers access to an enhanced pharmacy program offering specialized clinical services and 24 hour access to licensed healthcare providers and pharmacists. Diplomat has been serving patients for more than 35 years. It is the largest independently owned and operated specialty pharmacy in the nation. Specialty medications are often indicated to treat complex chronic health conditions. These medications may require special handling techniques, careful administration and a unique ordering process. That s why we offer this enhanced member service. You can access information about the clinical services and a list of eligible specialty medications on mymoda or through the WPDP/Moda Health Pharmacy Customer Service Department. Certain prescription drugs or medicines, including most self injectables and other medications defined as specialty products, must be purchased through Diplomat Specialty Pharmacy to be a covered benefit. In addition, these drugs will require prior authorization by Moda Health. More information is available on mymoda.

4 To assist you in making the transition to Diplomat, your new specialty pharmacy provider, the plan is offering a one month grace period. During this time, members may fill their first prescription at any participating NW Prescription Drug Consortium Network pharmacy. All future fills must go through Diplomat Specialty Pharmacy. If after the first month of therapy, you do not purchase these drugs at the in network specialty pharmacy provider, the drug expense will not be covered. Diplomat s dedicated team of pharmacists, nurses, patient care coordinators and specialty technicians will work with your healthcare team to coordinate your specialty care. They are dedicated to supporting you with education, compassionate counseling and injection training. The team can help you learn more about your health condition, manage medication side effects, understand dosage requirements and make informed choices about your healthcare Diplomat Customer Service: Fax: Hours: Monday Friday, 5:00 a.m. 8:00 p.m. PT; Saturday, 6:00 a.m. 2:00 p.m. PT diplomatpharmacy.com For information about specialty medications, or for a list of specialty medications, contact WPDP/Moda Health Pharmacy Customer Service at or online via your mymoda account. Can I call WPDP/Moda Health Pharmacy Customer Service? Yes. Moda Health welcomes any questions you may have. Our dedicated pharmacy customer service team is happy to assist you. A live person will answer your call during business hours. Simply call: WPDP/Moda Health Pharmacy Customer Service: Hours: Monday Friday 7:30 a.m. to 5:30 p.m. PT After hours, customer service is provided by MedImpact to ensure 24/7 support.

5 What is a generic drug? After the patent expires on a brand name drug, other companies are allowed to manufacture the drug as a generic equivalent. Because the drug can be produced by a variety of manufacturers, and due to this increased competition, the price of the drug decreases. An example is Tagamet (brand name) and Cimetidine (generic equivalent). Is a generic drug the same as a brand name drug? Generic drugs are approved by the Food and Drug Administration (FDA*) and contain the same active ingredients as their brand name counterparts. The generic equivalent drug has the same dosage form, strength and concentration, and is taken in the same way as the brand name drug. *The FDA is a U.S. government agency that regulates drug quality, strength and purity. Who makes generic drugs? Nearly two thirds of all generic drugs are manufactured by the same large pharmaceutical firms that make brand name drugs. All generic drugs are manufactured according to the same federal regulations as brand name drugs. In fact, several manufacturers make both generic and brandname versions of the same drug. Why use a generic drug? Choosing a generic drug can help keep down your health care costs. You pay a lower copayment if you chose a generic drug over the brand brand drug. What is my co payment for preferred versus non preferred drugs? With preferred brand drug coverage, your copayment is $20 for a 30 day supply and $40 for a 90 day supply. With non preferred brand coverage, your copayment is $40 for a 30 day supply and $80 for a 90 day supply via mail order. For more information about preferred or non preferred brands, visit modahealth.com What should I ask my doctor regarding the prescribed medications? Inform your doctor that your plan has implemented prescription care management programs. A

6 few prescription drugs may require prior authorization before they can be dispensed. If your prescription requires a prior authorization, your doctor must contact the clinical staff at Moda Health to avoid delays in your obtaining your medication. Your doctor may also need to contact the clinical staff at Moda Health regarding the quantity he/she is prescribing (see next question). What are quantity limitations? Limits based on the manufacturer s recommended daily dosage pertain to the number of tablets, patches, inhalers or bottles that will be covered each time a new or refill prescription is dispensed. Quantity level limits do not restrict the number of refills you may obtain. If your prescription order or refill exceeds the manufacturer s recommended daily dosage, your pharmacist will receive a message that Moda Health needs to review your prescription with your doctor. Your doctor must contact the Moda Health to determine if your medical condition qualifies you to receive the medication as your doctor is prescribing. Why are prior authorizations required? Prior authorizations for prescriptions help ensure that you receive the most effective treatment from specific medications and appropriate dosing of these drugs. Pre authorization also helps with cost containment Supporting your overall health is our primary concern. What if I'm told the pharmacy cannot fill my prescription? The pharmacist should explain why the prescription cannot be filled, and provide you with instructions on how to proceed. Usually, the pharmacy will provide a phone number for your doctor to contact Moda Health staff regarding the prescription. If this is an emergency situation, call Moda Heath at Discuss your prescription(s) and the prescription care management programs under the Plan with your physician at the time you are given a new prescription. This step can help eliminate delay in getting your prescription(s) filled at the pharmacy. If you have any questions or would like additional information on the certain, specific medications that may come under the prescription care management programs, please call Moda Health at or visit modahealth.com.