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Q&A: Pharmacy/Prescription Benefits

Q: Is there a discount for using the mail order service to fill my prescriptions?

A: Yes, for most prescriptions you can get “3 months for the price of 2”, meaning a 90-day supply for the price of two 30-day supplies (or two retail co-pays).  Certain drugs have restrictions that prevent them from being sent in larger quantites, or that prevent mail-order delivery altogether.  To get a detailed description of the cost savings for mail order vs. retail pharmacy, please view your specific Summary of Benefits and Coverage by clicking here.  You can confirm whether this discount is available for your particular prescription by calling OEBB Moda Health Pharmacy Customer Service at (866) 923-0411.

Q: How do I sign up for the mail-order prescription program?

A: There are 2 provider choices for mail order pharmacy services.  You can choose between Ardon Health Specialty Pharmacy and Postal Prescription Services (PPS).

  • Ardon Customer Service: (855)425-4085.  Monday – Friday: 8:00 a.m. – 7:00 p.m. PT and Saturday: 8 a.m. – 12 p.m. PT
  • PPS Customer Service: (800)552–6694.  Monday – Friday: 6 a.m. – 6 p.m. PT and Saturday: 9 a.m. – 2 p.m. PT
Q: How do I know whether my prescription is considered a “preferred brand”?

A: Moda regularly updates their prescription formulary, so you’ll want to check their web site to get the latest list. Click here for their pharmacy page, which contains many helpful links, including current and soon-to-be-effective prescription formularies.

Q: Does the deductible on my medical plan apply to prescriptions?

A: No, you do not have to meet a deductible in order to receive prescription benefits.  The benefits of the prescription coverage are available the first day your medical coverage is in effect.

Q: Is there a difference in pharmacy coverage depending on which medical plan I select?

A: Yes.  The copay amounts are different within the different networks.  Please review the Summary of Benefits and Coverage for the appropriate plan and network (either Connexus/Statewide/PPO or Synergy/CCM) here.

Q: Can I get prescription coverage without medical coverage?

A: No, the 4J plans have the prescription benefit tied in with the medical coverage — it is not available separately.