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Preferred Drug Program: A Program for Three-Tier Groups
Common Questions & Answers
Q. Does the Three-Tier Drug Program limit which drugs my physician can prescribe for me?
A. This list is not meant to replace a physician’s judgement for prescribing decisions. The ODS Preferred Drug Program is designed 2008 Preferred Drug Chart
to offer cost-effective choices that will save members money on prescription drugs. ODS does not take responsibility for any Preferred Drug Program: A Three-Tier Co-payment Program that Works for You medication decisions made by the prescriber or dispensing pharmacist.
Q. What if my prescribed drug is not listed on the chart?
Effective: January 1, 2008. For prior effective dates, please contact ODS Customer Service. A. The ODS Preferred Drug Chart is not an all-inclusive list. Generic drugs that do not appear on the list will be charged at the generic co-payment rate. Brand drugs for therapies not appearing on this list and that do not have less expensive brand and/or What is the ODS Preferred Drug Program?
generic alternatives available will be considered paid at the preferred rate. Newly FDA-approved medications not on this list The ODS Preferred Drug Program is designed to offer cost-effective choices that will save ODS members money on prescription will be considered as non-preferred until reviewed by the ODS Pharmacy and Therapeutics Committee.
Q. How will diabetic drugs and supplies be covered?
What makes the ODS Preferred Drug Program different?
A. Unless otherwise stated on the Preferred Drug Chart, diabetic and other covered supplies will be paid as preferred brand drugs.
The ODS Preferred Drug Program works differently than a typical drug formulary. Many drug formularies require you to use Refer to your member handbook for specific co-payment information.
the generic or low-cost brand drugs listed on their formulary and will not pay for any high-cost drugs not on that list. TheODS Preferred Drug Program offers more flexibility — members can choose high-cost drugs if they desire and still have a Q. How will compounded prescriptions be covered?
A. Compounded prescriptions will be paid as preferred brand drugs.
How does the program work?
Q. What if there is no generic alternative for the drug I am prescribed?
This program uses a three-tier co-payment system. Members can choose between generic, preferred brand name or non-preferred — each with a different co-payment amount. Your co-payment will vary depending on which drugs you choose. Our A. ODS recognizes that there are drugs for which there are no generic or brand alternatives. These drugs will be considered paid list of generic, preferred brand and non-preferred brand drugs are categorized for you on the following Preferred Drug Chart.
at the preferred or non-preferred brand co-pay.
In some cases, coverage levels may vary because of group-specific plan design and program initiatives.
Q. My physician prescribes a brand drug for me with no generic substitutions because it is the medication he feels works the
Generic Drug
Preferred Brand Drug
Non-Preferred Brand Drug
best in my situation. Does this mean I have to pay the brand co-pay?
A. If your physician has written a prescription for a branded product for which a generic is available but the physician has restricted generic substitution, you will pay the brand co-payment. Your individual prescription benefit may vary; please consult your member handbook for specific coverage information.
Q. If my physician does not restrict generic substitutions, but I want the preferred or non-preferred brand drug, what co-pay will
I have to pay?
A. If you are requesting the brand name drug be dispensed and your physician wrote a prescription for a branded product but did not restrict substitution, then — assuming the generic product is available — you would pay the preferred or non-preferred brand co-payment, plus the difference between generic and preferred or non-preferred brand price. Your individual prescriptionbenefit may vary; please consult your member handbook for specific coverage information.
Q. How do I use my mail order benefit?
A. Members have the option of obtaining a 90-day supply per prescription for covered maintenance drugs and medicines through our mail order pharmacy. Special mail order pharmacy forms are available from your employer, from ODS or on our website at G - generic drug
www.odscompanies.com. Refer to your member handbook for co-payment information.
P - preferred brand drug
NP - non-preferred brand
Q. When is the Three-Tier Drug Chart updated and how are members notified?
OTC - over-the-counter
A. Modifications to the list reflecting new drugs or changes in treatment patterns will be made throughout the year. The list is available on the ODS website at www.odscompanies.com or through the ODS Customer Service department.
More information about the Preferred Drug Chart is available on the ODS website at www.odscompanies.com or by calling
Pharmacy Customer Service at 503-243-3960 or 1-888-361-1610.
Insurance products are provided by ODS Health Plan Inc. and Oregon Dental Service. For a complete list of drugs that require prior authorization, go to www.odscompanies.com/members/pharmacy.
* Quantity limits based on FDA dosing guidelines.
G - generic drug P - preferred brand drug
NP - non-preferred OTC - over-the-counter
All drugs NOT listed are paid as generic or preferred. Newly FDA-approved medications not on this list will be considered non-preferred until reviewed by the ODS Pharmacy and Therapeutics Byetta injectablev
Symlin injectablev
Forteo injectablev
See your member handbook to find specific co-payment amounts and covered drugs.

Source: http://repro.salemkeizer.org/StaffCenter/Benefits/allstaff/OEA_Drug_List.pdf

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