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~~ 2004-2005 Preferred Drug Chart Preferred Drug Program - A Program for 3 Tier Groups A Three-Tier Copayment Program That Works For You What is the ODS Preferred Drug Program? The ODS Preferred Drug Program is designed to offer low cost choices that will save ODS members money on prescription drugs. What makes the ODS Preferred Drug Program different? The ODS Preferred Drug Program works differently than a typical drug formulary. Many drug formularies require you to use the generic or low-cost brand drugs listed on their formulary and will not pay for any high-cost drugs not on that list. The ODS Preferred Drug Program offers more flexibility as members can choose high-cost drugs if they desire and still have a portion of the costs paid by ODS. How does it work? This program uses aThree-Tier Copayment. Members can choose between generic, preferred brand name or non- preferred, high-cost drugs-each with a different copayment amount. Your copayment will vary depending on which drugs you choose. -Generic Drul; - .1 dru~~~ determined hip l~h~ ~ieian~ rind pharm~icist5 to be t}Zi~r ipcuticsll~- rqul~-alcut to the br; nd-n~inu~ ti-er;~ion. Cxar~ceic il~•u~Ts must cant.ain the :,ttu~c active in~re~lir~nt5 as their lreai~d- n,ime cr~unteel>~u•t u~d be ide~il.ic~~] in st~~c~ns.~i_h. dos<~~~e Turin and eout~° of~ ~idrnini~krat.iun. - Preferred Brand Z~ru~„ I>r.~ndr_drugs'.' that ha~~e, been re~-i~~~icd h~- ODS <ind f'r~u«d to be c liniaill~ ~~f'fecti~ i~ at fn~-~,raf~le cir~t~. `l'h~~-~~ drii~~~~ ~~arrv prci'crrcd ln•;u~d ~up~~~mei~~t. - Non-Preferred Brand Drug - Brand drugs that have been reviewed by ODS and found not to have a significant advantage over preferred brands, but usually cost more. Drugs that have alternative treatment modalities are also considered high-cost brand drugs. Our list of Generic, Preferred Brand and Non-Preferred Brand drugs are categorized for you on the following Preferred Drug Chart. You can find the Preferred Drug Chart on the ODS website at: www.odscompanies.com. - Quantity limits based on FDA dosing guidelines -Paid as Preferred with Prior Authorization (PA) approval How to Read Your Preferred Drug Chart Drug Categor Ti Li ti y ~~ Allergy -Oral & Inhaled ~ er s ngs; G-Generic Drug G "`P `'!.,' NP P-Preferred Brand Allegra $~~$ Drugf Drug Name & ~~ Allegra-D $~S~ NP-Non-Preferred Restrictions Astelin ` ~ Brand Drug OTC-Over-The- (generic drugs chlorpheniramin~ OTC Counter Drug are listed in lower Clarinex ~~~~ , not covered case; this is most likely how they Claritin OTC '' See your member will appear on Clai~;r;~,-1~ OTC handbook to find your prescription) cyproheptadine ? specific copayment __ dexchlorpheniramine amounts.