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Preferred Drug Program - A Program for 3 Tier Groups <br />Common Questions & Answers <br />Q. Does the Three-Tier Drug Program limit which drugs my physician can prescribe for me? <br />A. This list is not meant to replace a physician's judgement for prescribing decisions. The ODS Preferred Drug <br />Program is designed to offer low cost choices that will save the member or members money on prescription drugs. <br />ODS does not take responsibility for any medication decisions made by the prescriber or dispensing pharmacist. <br />Q. What if my prescribed drug is not listed on the chart? <br />A. The ODS Preferred Quick Reference Drug Chart is not an all-inclusive list. Generic drugs that do not appear on <br />the list will be charged at the generic copay rate. Brand drugs for therapies not appearing on this list and which do <br />not have less expensive brand and/or generic alternatives available, will be considered paid at the preferred rate (ie. <br />Copaxone for Multiple Sclerosis). Newly FDA approved medications not on this list will be considered as high cost <br />drugs until reviewed by the ODS Pharmacy and Therapeutics Committee. <br />Q. How will diabetic drugs and supplies be covered? <br />A. Diabetic and other covered supplies will be paid as preferred brand drugs. Refer to your member handbook for <br />your specific copayment information. <br />Q. How will compounded prescriptions be covered? <br />A. Compounded prescriptions will be paid as preferred brand drugs. <br />Q. What if there is no generic alternative for the drug I am prescribed? <br />A. ODS recognizes that there are diseases and drugs for which there are no generic or brand alternatives. These <br />drugs will be considered paid at the preferred brand rate. <br />Q. My physician prescribes a brand drug for me with no generic substitutions because it is the <br />medication he feels works the best in my situation. Does this mean I have to pay the brand copay? <br />A. If your physician has written a prescription for a branded product for which a generic is available, but the <br />physician has restricted generic substitution, you will pay the brand copayment. Your individual prescription benefit <br />may vary; please consult your member handbook for specific coverage information. <br />Q. If my physician does not restrict generic substitutions, but I want the preferred or non-preferred <br />brand drug, what copay will I have to pay? <br />A. If you are requesting the brand name drug be dispensed, and your physician wrote for a branded product but did <br />not restrict substitution, then, assuming the generic product is available, you would pay the preferred or non- <br />preferred brand copayment plus the difference between generic and preferred or non-preferred brand price. Your <br />individual prescription benefit may vary; please consult your member handbook for specific coverage information. <br />Q. How do I use my mail order benefit? <br />A. Members have the option of obtaining a 90-day supply per prescription for covered maintenance drugs and <br />medicines through our mail order pharmacy. Special mail order pharmacy forms are available from your employer, <br />from ODS or on our website at www.odscompanies.com. Refer to your member handbook for copayment <br />information. <br />Q. When is the Three-Tier Drug Chart updated and how are members notified? <br />A. Modifications to the list to reflect new drugs or changes in treatment patterns will be made periodically <br />throughout the year. The list is available on the ODS website at www.odscompanies.com or through the ODS <br />Customer Service Department. <br />More information about the Preferred Drug Chart is available on the ODS website at: www.odscompanies.com or <br />by calling ODS at 503-228-6554 or 1-800-852-5195. <br />Insurance products are provided by ODS Health Plan, Inc. and Oregon Dental Service. <br />