Frequently Asked Questions
Prescription Plan Manager for Moda Plans Changing on January 1, 2025
We are pleased to announce that, effective January 1, 2025, the County has chosen a new prescription drug vendor for Moda plans. Moda Health! This change will affect employees enrolled in Moda Health plans as of that date. We anticipate that this change will enhance the transparency of prescription costs and provide better service and ease of use for Moda members utilizing their prescription benefits. See our FAQs below for more information on this transition.
Why is the County making this change? Our team received consistent feedback about challenges with customer service, understanding costs and coverage, and other issues with WellDyneRx. As a result, we conducted a thorough evaluation of our pharmacy benefit manager (PBM) with a focus on customer service and transparency.
We have selected the ArrayRx pharmacy benefit program, administered by Moda, a local business. With the integration of Moda’s pharmacy and medical services and Moda’s local footprint, we expect this change will enhance the pharmacy benefit experience and improve pharmacy program customer service.
- NOTE: This change will not impact people who are on Kaiser plans.
When will the change be effective?
January 1, 2025
Will this change be part of Open Enrollment for next year?
Yes, if you are currently on a Moda medical plan and not moving to Kaiser, and if you are moving from Kaiser to Moda, the change will be effective January 1, 2025.
- REMINDER: Be sure to review your benefits every year and finalize your Open Enrollment (check the box to sign and click Submit) in Workday to confirm all of your plans, dependents and costs are as you wish for 2025.
Will our medical plans be changing?
No, the medical plans will stay nearly the same for 2025. Check the Open Enrollment page for updates on annual rate changes and minor regulatory adjustments.
Will my dental plan with Delta Dental or my vision plan with Vision Service Plan (VSP) change?
There will be no impact on dental or vision coverage.
Will I receive new ID cards? When?
Yes, if you elect Moda medical coverage in 2025, you should receive your new member cards with updated pharmacy information on or before January 1, 2025. You will need to share that information with your pharmacy.
Is my pharmacy in-network with the ArrayRx program at Moda?
The ArrayRx Core Network at Moda is nearly equivalent to WellDyne, with the exception that CVS pharmacies are not in-network. Moda will notify plan members who have recently filled prescriptions at a CVS pharmacy that they will need to use in-network pharmacies to get the best benefit. You can search for a pharmacy with the Pharmacy Search tool.
If you use a pharmacy that will be out of network for 2025 and your prescription has refills available, you may be able to transfer it to an in-network pharmacy. (Otherwise, please request a new prescription from your prescriber and ask that it be sent to an in-network pharmacy.) To transfer: contact the new pharmacy and provide the name(s), dosage(s), and prescription number(s) of the prescription(s) you want to transfer and the contact details of the current pharmacy. Then the new pharmacy can contact the current pharmacy to begin the transfer.
Will my medications be covered after the change?
In our analysis, there are a small number of members that would be impacted by changes that will happen to the prescription drug formulary (the list of medications that the plan covers and the cost tier of these drugs). Moda will be reaching out to impacted employees.
Will I be able to get mail order medications with Moda?
Yes, mail order will be an option. Mail order prescriptions will be available from Postal Prescription Services (a local company) and Costco (also a Pacific Northwest based company).
If you haven’t previously used mail order services, you will be able to compare costs and see potential savings in the Moda Member Dashboard starting January 1, 2025. Moda’s Pharmacy Customer Service team will also be able to help you with your pharmacy benefit needs and questions starting January 1, 2025.
How is the County going to ensure a smooth transition to the ArrayRx pharmacy benefit program with Moda?
While all changes have the potential for a few bumps in the road, we are working to make this a smooth transition for Moda members. This transition management includes but is not limited to:
- Moda will have WellDyneRx claims, prior authorization, overrides, and medication step therapy information prior to January 1, 2025, to better transition members with medications that are subject to these limitations.
- Moda will directly inform members who will be affected by prescription drug formulary changes.
- Moda will communicate directly with members who will need to change pharmacies. NOTE: There are minimal network changes, so this will mostly affect members who recently used CVS pharmacies.
- We will promptly update this page and Open Enrollment pages with new information as it becomes available.
- Consider filling your prescription(s) for the maximum days supply one more time with your current pharmacy before the end of 2024.
Can I check the Moda formulary myself?
Yes, you can view the Preferred Drug List (PDL).This will provide the tier of medications in the Moda formulary.
Will my medication costs change with ArrayRx?
You can find the tier of your current medications in the Preferred Drug List (PDL)
| PDL Tier | Moda PPO 400 Tier |
|---|---|
| Value & Preventative | Value |
| Select | Tier 1 |
| Generic Specialty | Tier 1 |
| Preferred Brands | Tier 2 |
| High Cost Generics | Tier 2 |
| Preferred Specialty | Tier 2 |
| Non-Preferred Brands | Tier 3 |
| Non-Preferred Specialty | Tier 3 |
| EXC - Plan Exclusion | Not Covered |
Then, use the charts below to see your costs.
PPO 400 -Medication Tiers & Employee Costs
| Retail 30 Day Supply | Retail 90 Day Supply | Mail Order 90 Day Supply |
|---|---|---|
| Value Tier: ≤$4 | Value Tier: ≤$12 | Value Tier: ≤$8 |
| Tier 1: 20%, max of $50 | Tier 1: 20%, max of $150 | Tier 1: 20%, max of $30 |
| Tier 2: 20%, max of $50 | Tier 2: 20%, max of $150 | Tier 2: 20%, max of $125 |
| Tier 3: 50% | Tier 3: 50% | Tier 3: 50% |
Moda Major Medical - Medication Tiers & Employee Costs
| Retail 30 Day Supply | Retail 90 Day Supply | Mail Order 90 Day Supply |
|---|---|---|
| Value Tier: ≤$4 | Value Tier: ≤$12 | Value Tier: ≤$8 |
| Tier 1: 30% after deductible | Tier 1: 30% after deductible | Tier 1: 30% after deductible |
| Tier 2: 30% after deductible | Tier 2: 30% after deductible | Tier 2: 30% after deductible |
| Tier 3: 30% after deductible | Tier 3: 30% after deductible | Tier 3: 30% after deductible |
*Medication prices vary between pharmacies and can change at the same pharmacy location due to market demand and price fluctuations. Prescription cost changes after the transition, or anytime throughout the year, may not be due to the plan, but rather expected fluctuation in prices as are typical in the market. See further prescription plan details on the Medical Plan Comparison.
Will I be able to compare prices for my medications?
Yes! Starting January 1, 2025, you will have access to the drug price check tool through your Moda Member Dashboard! There you can compare prices among pharmacies so you can make informed decisions when choosing a pharmacy. Our team is very excited about this tool and the savings potential for Moda members!
Does my prescription drug deductible start over again on 1/1 of each new year?
Yes, January 1, 2025 starts a new plan year with new deductibles.
- NOTE: Moda PPO 400 plan members do not have a prescription plan deductible.
Who can I contact with questions/concerns about this change? What if I have issues with my prescription drug benefits with Moda?
The benefits team is here to help you! Contact us at employee.benefits@multco.us. You can also leave us a message at 503-988-3477. Or, come to our office at 501 SE Hawthorne - Suite 300. We’re in the office from 7:30am to 5:00pm Tuesday, Wednesday, and Thursday.
You can reach Moda Pharmacy Customer Service at 800-913-4284. You can also email customer service at MultCountyCS@modahealth.com.