Provider : Pharmacy Information

The Preferred Drug List (PDL) is a standardized prescribing reference and clinical guide of prescription drug products selected by 'Ohana’s Pharmacy and Therapeutics Committee. The selection of drugs is based on the drugs’ efficacy, safety, side effects, pharmacokinetics, clinical literature and cost-effectiveness profile

Most medications on the PDL are covered without prior authorization or Drug Evaluation Review (DER). Some PDL items, however, are only covered after undergoing a DER. Medications that require a DER are noted with a “PA” (prior authorization) or “ST” (step therapy) listed next to the medication. Non-PDL medications require the submission of a Coverage Determination Request Form.

All psychotropic medications are covered and do not require a DER.

• Preferred Drug List(Medicaid)
• Preferred Drug List for Dual-Eligible Members
• Cough and Cold Alternatives Drug List
• Pharmacy Updates
• Drug Evaluation Review Process

Pharmacy Forms

• Accu-Chek Meter Form
• Bayer Meter Form
• Injectable-Infusion Form (Medicaid)
• Injectable-Infusion Form (Medicare)
• Coverage Determination Request Form (Medicaid)
• Coverage Determination Request Form (Medicare)
• Synagis Form

The ‘Ohana Health Plan Pharmacy Department telephone number is 1-888-505-1198.

For detailed information about pharmacy services, refer to the Pharmacy section of the 'Ohana Provider Manual.