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Drug List

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2020

‘Ohana Community Care Services (CCS) Comprehensive Preferred

Drug List

(List of Covered Drugs)

‘Ohana Health Plan

00

Please read: This document contains information about the drugs we cover in this plan.

Please note that the ‘Ohana Community Care Services (CCS) Preferred Drug List is updated quarterly.

Providers, please visit our website at https://www.ohanaccs.com/provider/pharmacy to view updates to the preferred drug list.

Members, please visit our website at https://www.ohanaccs.com/member/pharmacy to view updates to the preferred drug list.

Last updated (3/01/2020)

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Key UPPER CASE = Brand Name Drugs QL = Quantity Limit Lower case italics = Generic Drugs ST = Step Therapy PDL = Preferred Drug List AL = Age Limit PA = Prior Authorization YOA =

Please carefully review these changes: Key UPPER CASE = Brand Name Drugs QL = Quantity Limit Lower case italics = Generic Drugs ST = Step Therapy PDL = Preferred Drug List AL = Age

Please carefully review these changes: Key UPPER CASE = Brand Name Drugs QL = Quantity Limit Lower case italics = Generic Drugs ST = Step Therapy PDL = Preferred Drug List AL = Age

Please carefully review these changes: Key UPPER CASE = Brand Name Drugs QL = Quantity Limit Lower case italics = Generic Drugs ST = Step Therapy PDL = Preferred Drug List AL = Age

Please carefully review these changes: Key UPPER CASE = Brand Name Drugs QL = Quantity Limit Lower case italics = Generic Drugs ST = Step Therapy PDL = Preferred Drug List AL = Age

Please carefully review these changes: Key UPPER CASE = Brand Name Drugs QL = Quantity Limit Lower case italics = Generic Drugs ST = Step Therapy PDL = Preferred Drug List AL = Age

Please carefully review these changes: Key UPPER CASE = Brand Name Drugs QL = Quantity Limit Lower case italics = Generic Drugs ST = Step Therapy PDL = Preferred Drug List AL = Age

Key UPPER CASE = Brand Name Drugs QL = Quantity Limit Lower case italics = Generic Drugs ST = Step Therapy PDL = Preferred Drug List AL = Age Limit PA = Prior Authorization YOA =