GENERIC DRUGVOUCHER PROGRAM
A COST-SAVING ALTERNATIVE
The rising cost of medication is a concern for healthinsurance members, employers and physicians. As oneresponse to this concern, The ODS Companies (ODS) hasdeveloped the Generic Drug Voucher Program. The voucherprogram is designed to promote the use of safe andeffective medications that are not available as samplesat the doctor’s office.
For participating employer groups, the Generic Drug VoucherProgram allows members with prescription coverage throughODS to receive an initial 30-day supply of a selected genericdrug at a one-time $0 copayment.
The voucher can be found on page 2 of this document and isalso available at www.odscompanies.com through yourmyODS online account, at participating employer groupintranet sites or by mail when requested from ODS.
AT YOUR PROVIDER’S OFFICE
Members are encouraged to take avoucher to their provider appointments todiscuss if any of the vouchermedications would be appropriateas either a new medication or analternative to a medication theyare currently taking. If themember’s physician agrees thatone of the medications listed onthe voucher would beappropriate, the member shouldobtain a new prescription from hisor her physician to present at thepharmacy with the voucher.
AT YOUR PHARMACY
The preferred generic voucher form must be accompaniedby a new prescription. Your pharmacy will use theinformation on the voucher form to process theprescription at a one-time $0 copayment. Vouchers arevalid for only one drug at a time. The $0 copaymentapplies only once to the selected medication; anysubsequent refills will be subject to the copayment andprescription benefit guidelines for your program.
Voucher forms are only available to members anddependents of employer groups who participate inthis program.
Please keep in mind that your physician can best assessthe appropriateness of a medication available throughthe voucher program for your individual treatment.
Manage your benefits andaccess helpful tools and
resources online atwww.odscompanies.com
801162 (12/08) Rx-1090-COE
Drug Class Generic Drug Name Equivalent To Strength
ALLERGY/SINUS � Fluticasone nasal spray Flonase 50mcg/act
ANTIDEPRESSANT � Bupropion SR Wellbutrin SR 150mg
� Fluoxetine Prozac 10mg
� Fluoxetine Prozac 20mg
� Sertraline Zoloft 25mg
� Sertraline Zoloft 50mg
BLOOD PRESSURE � Amlodipine Norvasc 5mg
� Amlodipine Norvasc 10mg
� Atenolol Tenormin 50mg
� Hydrochlorothiazide Hydrodiuril 12.5mg
� Hydrochlorothiazide Hydrodiuril 25mg
� Lisinopril Zestril 10mg
� Metoprolol succinate Toprol XL 100mg
CHOLESTEROL � Lovastatin Mevacor 20mg
� Simvastatin Zocor 40mg
DIABETES � Glimepiride Amaryl 2mg
� Glipizide Glucotrol 5mg
� Glyburide Diabeta 5mg
� Metformin Glucophage 500mg
� Metformin Glucophage 1000mg
MIGRAINE � Sumatriptan Imitrex 50mg
� Sumatriptan Imitrex 100mg
PAIN/ARTHRITIS � Ibuprofen Motrin 800mg
� Naproxen Naprosyn 500mg
OSTEOPOROSIS � Alendronate Fosamax 10mg
� Alendronate Fosamax 70mg
STOMACH/ULCER � Omeprazole Prilosec 20mg
� Pantoprazole Protonix 40mg
� Ranitidine Zantac 150mg
Directions for Pharmacy
� Submit for drug on front ofvoucher as usual prescription
� Plan will pay all prescriptioncosts (no patient copayment)
� Plan name: ODS
� Carrier number: 38629
� Enter patient ID frommember card
� Enter person code frommember card
� Enter group number frommember card
� No reimbursement claim maybe submitted with respect tothe product covered byvoucher
� Call MedImpact at800-788-2949 or ODSPharmacy Customer Serviceat 888-361-1610
Good for initial prescription,one-time only. Refills followusual procedure.
This is a voucher only — do not dispense unless accompanied by a prescription.No co-payment on first 30-day prescription for the drugs listed below.
EFFECTIVE 1/1/2009
CITY OF EUGENE — CITY HEALTH PLANGENERIC DRUG VOUCHER PROGRAMDRUG LIST
