ODS. Healthcare from your head to your toes.

Preferred Drug Program

The ODS Preferred Drug Program offers a choice of medications that are effective treatments and provide value to ODS pharmacy members by saving them money on prescription drug costs.

Preferred Drug List
Value Tier Listing
Specialty Medications List

For member specific answers to the questions below, and to determine which PDL applies to your patient, please log in to Benefit Tracker or call ODS Pharmacy Services.

How does the program work?

This program uses a tiered copay system. Members and their doctors can choose between value tier, generic (tier 1), preferred (tier 2) or brand (tier 3) drugs. Each tier has a different copay amount and will depend on the member’s benefit. Refer to the Member Handbook for specific tier and coverage information. To determine which PDL applies to your patient, please log into Benefit Tracker.

Who makes decisions about drugs on the Preferred Drug List?

The list is developed and maintained by a committee comprised of doctors and pharmacists called the Pharmacy and Therapeutics Committee. The committee makes decisions based on information about the drug’s safety, effectiveness and associated clinical outcomes.

What makes the ODS Preferred Drug Program different?

ODS offers more flexibility; members can choose high-cost drugs if they want to and still have a portion of the costs paid by ODS. Many 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.

Does the tiered drug program limit which drugs physicians can prescribe?

This list is not meant to replace a doctor’s judgment for prescribing decisions. The ODS Preferred Drug Program is designed to offer cost-effective choices that will save members money on prescription drugs. ODS does not take responsibility for any drug decisions made by the prescriber or dispensing pharmacist.

What if a prescribed drug is not listed on the chart?

The ODS Preferred Drug List is not an all-inclusive list. Generic drugs that do not appear on the list will be paid at the generic (tier 1) copay. Brand drugs that do not appear on this list that do not have less expensive brand or generic alternatives will be paid at the preferred (tier 2) copay. Drugs that are new to the market and not on the list will not be covered until reviewed by the Pharmacy and Therapeutics Committee. For more information on new drugs to the market, please call ODS Pharmacy Customer Service.

How will diabetic drugs and supplies be covered?

Bayer and Lifescan diabetic supplies are the preferred (tier 2) products. In addition, a free blood glucose meter is available for the preferred meters (Bayer or Lifescan). For more information about this program please call ODS Customer Service.

Can members get brand drugs for a generic copayment?

If a member requests a brand name drug or the prescribing physician prescribes a brand name drug when a generic equivalent is available, the member will be responsible for the brand copayment plus the difference in cost between the generic and the brand name drug. Members should consult their Member Handbook for specific coverage information.

How do members use their mail-order benefit?

Members may obtain a 90-day supply per prescription through our mail-order pharmacy. Special mail-order pharmacy forms are available for members in their myODS account. Members should refer to their Member Handbook for copayment information.

When is the three-tier drug list updated?

Modifications to the list reflecting new drugs or changes in treatment patterns will be made throughout the year. When a generic becomes available for a brand name medication, the brand name drug will be moved to the Brand Tier (3).