Pharmacy

Formulary

Explore our medication lists to see covered prescription medications and other coverage requirements.

• Covered drugs list tool - see what prescriptions the pharmacy plan covers
• Complete list of formulary medications
  • List of formulary medications machine readable file A to D 
  • List of formulary medications machine readable file E to M 
  • List of formulary medications machine readable file N to Z 
• Summary of Changes
• Outpatient Pharmacy Criteria Policies

Provider Administered Drugs

EOCCO partners with Prime Therapeutics Management to assist in medical pharmacy management through the provider administered injectable medication program. Prime Therapeutics Management will review your prior authorization requests for the following specialty injectable medications that are administered in:

• an outpatient facility
• a patient's home
• a physician's office

Injectable Medication Prior Authorization List
Injectable Medication/Medicaid Pharmacy Policies

Specialty Pharmacy

Forms

• Prior authorization form
• Claim Forms
• Notice of hearing rights
• Appeal form
• Complaint form

Networks

Members have access to the Navitus pharmacy network.

• Find an in-network pharmacy in the Navitus pharmacy network

Discounts

If you need a medication that is not covered under your pharmacy plan, you can use the ArrayRx discount card to help you save money on your prescription. It’s free and sign-up is easy.

• Learn more about the ArrayRx discount drug card program

Questions?

Contact the Moda Health Pharmacy Customer Service team at 888-474-8539.