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Preferred Drug Program FAQ
- How do I know if I have this drug program?
- Does the Preferred Drug Program limit which drugs my physician can prescribe for me?
- What if my prescribed drug is not listed on the chart?
- How will diabetic drugs and supplies be covered?
- How will compounded prescriptions be covered?
- What if there is no brand alternative for the drug I am prescribed?
- My physician prescribes a brand drug for me with no generic substitutions because it is the medication he feels works the best in my situation. Does this mean I have to pay the brand co-pay?
- If my physician does not restrict generic substitution but I want the preferred or premium brand drug, what co-pay will I have to pay?
- How do I use my mail order benefit?
- When is the Preferred Drug Chart updated and how are members notified?
How do I know if I have this drug program?
Your benefit summary or member handbook will tell you more about your pharmacy benefits. You can still save money using generic or preferred drugs even if you do not have a three-tier co-payments.
Does the Preferred Drug Program limit which drugs my physician can prescribe for me?
This list is not meant to replace a physician's judgment for prescribing decisions. ODS does not take responsibility for any medication decisions made by the prescriber or pharmacist. These decisions are to be made by the physician and pharmacist using their medical and professional judgment.
What if my prescribed drug is not listed on the chart?
The ODS Preferred Quick Reference Drug Chart is not an all-inclusive list. Generic drugs that do not appear on this list will be charged at the generic co-pay rate. Brand drugs for therapies not appearing on this list and which do not have less expensive brand and/or generic alternatives available, will be considered paid at the preferred brand rate (ie: Copaxone for Multiple Sclerosis). Newly FDA approved medications not on this list will be considered as high cost drugs until reviewed by the ODS Pharmacy and Therapeutics Committee.
How will diabetic drugs and supplies be covered?
Diabetic and other covered supplies will be paid as preferred brand drugs.
How will compounded prescriptions be covered?
Compounded prescriptions will be paid as preferred brand drugs.
What if there is no brand alternative for the drug I am prescribed?
ODS recognizes that there are diseases for which there are no generic or brand alternatives. These drugs will be considered paid at the preferred brand rate.
My physician prescribes a brand drug for me with no generic substitutions because it is the medication he feels works the best in my situation. Does this mean I have to pay the brand co-pay?
Yes. If your physician has written for a branded product for which a generic is available but the physician has restricted generic substitution, you will pay the brand co-payments
If my physician does not restrict generic substitution but I want the preferred or premium brand drug, what co-pay will I have to pay?
If you are requesting the brand name drug be dispensed and your physician wrote for a branded product, but did not restrict substitution, then assuming the generic product is available, you would pay the preferred or premium brand co-payments plus the difference between the generic and preferred or premium brand price.
How do I use my mail order benefit?
Members have the option of obtaining a 90-day supply per prescription for covered maintenance drugs and medicines through the Mail Order Pharmacy. Special Mail Order Pharmacy forms are available from your employer or from ODS. Refer to your Member Handbook for co-payments information.
When is the Preferred Drug Chart updated and how are members notified?
Modifications to the list to reflect new drugs or changes in treatments patterns will be made periodically throughout the year. View the Preferred Drug Chart (PDF).