Pharmacy Resources
Providence Health Plan is pleased to provide plan members with a comprehensive prescription drug formulary (list of covered drugs) designed to promote safe, effective, and affordable drug therapy.
Your formulary is easy to search, includes information about the drug, and includes special considerations about the prescription, if they apply.
Pharmacy Resources flyerFinding and searching your formulary
Find your pharmacy benefit formulary below by first selecting the type of health plan you have, then clicking on the link for the formulary that applies to your medical plan. Once selected, you can search your online formulary for the prescriptions you are inquiring about. The online search results will provide information about the tier the drug may be on and any associated restrictions (such as prior authorization or quantity limitations).
Formulary Exception: There may be times when you require a drug that is not on the formulary. If you currently take a prescription drug not on the formulary, contact customer service to make sure the drug is not covered. If the prescription drug is not covered, your provider may request an exception be made. There are two ways you, your representative or prescriber can initiate a prior authorization request: Complete the Providence Health Plan drug coverage prior authorization form or your provider may use the drug prior authorization form to submit the exception request.
Generic Alternatives: A generic alternative is a generic drug that is used to treat the same condition as a brand-name drug; it is not the exact same medication as the brand-name drug. According to clinical evidence, a generic alternative can be expected to treat the same condition as well as the brand-name alternative. A new prescription is needed to obtain a generic alternative drug. You may search the formulary by medical condition category and look for a medication classified as generic.
What kind of health plan do you have?
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I have an Individual & Family plan
Prescription drug coverage effective on or after Jan. 1, 2024
2024 Product
Formulary
Connect (OR)
Standard (OR)
Providence Oregon Direct (OR)
2024 Formulary N
HSA (OR) 2024 Formulary N-HSA Columbia (WA) 2024 Formulary M
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I have a Medicare or Medicaid plan
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I have a small group employer plan
Prescription drug coverage effective on or after Jan. 1, 2024
2024 Product
Formulary
Balance
Choice
Connect
Standard
Total Enhanced
2024 Providence Formulary P
HSA 2024 Providence Formulary P-HSA
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I have a large group employer plan
Prescription drug coverage effective on or after Jan. 1, 2024
2024 Product
Pharmacy Plan
Formulary
Choice
Connect
Option Advantage Base
Option Advantage Plus (A)
Option Advantage Premium (B)
Out of Area
Personal Option
Traditional Option6 Tier Plan
2024 Providence Formulary P 2 Tier Plan
2024 Providence Formulary A Value Plan
Value Plan
2024 Providence Formulary D HSA
HSA Qualified Plans with Safe Harbor (6-Tier)
2024 Providence Formulary P-HSA
If you are employed by one of the following, select your formulary here:
Employer
2024 Formulary
Clackamas County - POA Formulary A
AFC Urgent Care
Clackamas County - General
CollegeNet
Excelsior Wellness
Goodwill Industries
Oregon Brewing
Ortho & Fracture Specialists - Option Advantage B
Pathway Enterprises
SAIF
Formulary BBend Chamber of Commerce
Valley View HealthFormulary B - Preventive Harrison Electrical Workers Trust (Rx Only) Formulary B - Harrison Intel Formulary C PEBB Formulary D AFC Urgent Care - HSA
Ortho & Fracture Specialists - HSAFormulary F Benchmade Knife - Connect
Combined Transport
Marathon Coach - Option Advantage
Nosler Inc
Riverpoint MedicalFormulary J Benchmade Knife - HSA
Kalispell Public Schools
Marathon Coach - HSA
Hydra-Power SystemsFormulary K Covenant
Kadlec
PacMed
PSJH
SJH
SwedishFormulary L 9Wood
East West Tea
Harrison Electrical Workers Trust
Jet Industries
Oregon Episcopal School
Rebound Orthopedics & Neurosurgery
Formulary P 9Wood - HSA
East West Tea - HSA
PGEFormulary P-HSA
There are multiple formularies posted on the Providence Health Plan (PHP) website. If you need assistance determining which formulary applies to you, it can be found by logging in to your myProvidence.com account or by calling PHP Pharmacy Customer Service at 503-574-7400 or 877-216-3644.
Requesting authorization for your drugs
You can use the formulary information above to determine if your drug requires prior authorization or has any other restrictions. To request authorization or an exception to any restrictions, your doctor can complete one of the following forms or you can use the secure email link and submit to the health plan.
Participating pharmacies
You have access to more than 36,000 participating pharmacy locations nationwide.
Find a pharmacyRetail pharmacy
A retail pharmacy can provide up to a 30-day supply of prescription drugs. Search the pharmacy directory for a pharmacy near you.
Preferred retail pharmacy
A preferred retail pharmacy can provide up to a 90-day supply of prescription drugs. Search the pharmacy directory for a pharmacy near you.
Mail-order pharmacy
A mail-order pharmacy can provide up to a 90-day supply of maintenance drugs and specializes in direct delivery to your home.
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Costco Home Delivery
As a Providence Health Plan member, you have access to full-service mail-order prescription services through Costco Home Delivery.
Costco Home Delivery offers affordable prescriptions, outstanding customer service and free standard shipping on all orders. You may also call a pharmacist for consultation any time during business hours.
Who is eligible?
Costco Home Delivery will verify your eligibility when you register.
All covered members and their qualified dependents have access to this mail order pharmacy. For non-Medicare and non-Medicaid plans, your network provisions may require the use of just one mail order pharmacy for coverage. Please call the Providence Health Plan Pharmacy Department at 877-216-3644 if you have questions.
Order prescriptions by mail
- Use this guide to help in creating an account with Costco Home Delivery online at www.costco.com/Pharmacy/home-delivery
- Costco pharmacy agents are available at 800-607-6861, 5 a.m. to 7 p.m. (Pacific Time), Monday - Friday, 9:30 a.m. to 2 p.m. (Pacific Time), Saturday
- Your doctor may also fax in new or refill orders at 800-633-0334
- Refer to your prescription drug benefit summary for plan details
Costco contacts, FAQ, and how-to guide
Contact information
Mon – Fri 5 a.m. to 7 p.m. PT, Sat 9:30 a.m. to 2 p.m. PT
Pharmacy is available 24/7 to refill prescriptions, order new prescriptions and check prescription status.
Phone:
Fax:
Mailing address:
802 134th St. SW Ste 140, Everett, WA 98204-7314
Contact Costco Home Delivery Pharmacy email:
mail to: webpharmacy@costco.com
Costco Home Delivery contracts with Providence Health Plan as a participating pharmacy for members. You are responsible for arrangement of services and/or payment of services directly to Costco Home Delivery.
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Postal Prescription Services
As a Providence Health Plan member, you have access to full-service mail-order prescription services.
Postal Prescription Services offers affordable prescriptions, outstanding customer service and free standard shipping on all orders. You may also call a pharmacist for consultation any time during business hours.
Who is eligible?
All covered members and their qualified dependents. Postal Prescription Services will verify your eligibility when you register.
Your network provisions may require the use of just one of these mail-order pharmacies for coverage. Please call the Providence Health Plan Pharmacy Department at 877-216-3644 if you have questions.
Order prescriptions by mail
- Download this guide to creating an account with Postal Prescription Services online at www.ppsrx.com or call 503-797-2100 or 800-552-6694 (Mon – Fri 6 a.m. to 6 p.m. PT, Sat 9 a.m. to 2 p.m. PT)
- Order or refill your prescription online, or call 800-552-6694 – available 24/7, 365 days a year
- Your doctor may also fax in new or refill orders at 800-723-9023
- Refer to your prescription drug benefit summary for plan details
Questions?
Contact Postal Prescription Services at:
Website:
Phone:
6 a.m. to 6 p.m. (Pacific Time), Monday - Friday
9 a.m. to 2 p.m. (Pacific Time), Saturday
Mailing address:
PO Box 2718, Portland, OR 97208
Automated refill line available 24/7, 365 days a year:
Postal Prescription Services contracts with Providence Health Plan as a participating pharmacy for members. You are responsible for arrangement of services and/or payment of services directly to Postal Prescription Services.
Specialty pharmacy
Specialty drugs are prescriptions that require special delivery, handling, administration and monitoring by a pharmacist. These drugs are listed on the Providence Health Plan formulary with a status of "specialty."
- Specialty drugs are available through Credena Health.
- Some specialty drugs are denoted as Limited Access (LA) on the formulary. Credena Health may not be able to provide some of these drugs since they are limited to only a few specialty pharmacies. For more information, call Customer Service at 877-216-3644 (TTY: 711), Monday through Friday, 8 a.m. to 6 p.m. (Pacific Time).
Smart RxAssistTM
A program that may help you lower your copay cost on certain high-cost medications.
Smart RxAssist reduces your copay to $0 on select specialty medications. Eligible members* are enrolled automatically. A specialized patient navigator will assist you every step of the way.
Program Features and Eligibility
The Smart RxAssist program helps lower your out-of-pocket costs to $0 for eligible specialty medications. In some cases, you may have a small fee which you will be reimbursed for via check within 45 days.
- There is no cost to you for participating in the Smart RxAssist program.
- The medications currently eligible for the Smart RxAssist program are listed below. Medications eligible for the program are subject to change.
- Because this program provides a $0 cost not subject to deductible, the tax laws regarding a health savings account makes the program unavailable to those enrolled in the Health Savings Account (HSA) medical plan.
*HSA, Medicare, Medicaid, Members 65 years and older, and Washington plan-based members are ineligible for the Smart RxAssist Program.
Fertility Pharmacy
Most fertility medications are highly specialized and require specific training from your clinic and specialty pharmacy staff. These are pharmacies with expertise in fertility medications.
Medical benefit drug authorization
The following list is intended to provide guidance regarding coverage of drugs that are typically administered by a healthcare professionals (such as your doctor) and is not all-inclusive. Additional exclusions may apply based on benefit and contract terms. For pharmacy benefit drug prior authorization information, please refer to your current formulary above.
- Medical Service Prior Authorization List (PDF)
This list includes medications that are injected, infused or otherwise administered by a health care professional that are covered under your medical benefit.
Infusion Therapy Site of Care Policy – Commercial Members (Individual & Family, Small and Large Employer Group Plans)
Infused drugs are covered under your medical benefit. Providence Health Plan (PHP) requires site of care prior authorization for the drugs listed below when given in an unapproved hospital outpatient setting. A separate prior authorization may be required for the drug.
Please Note: This policy only applies if you receive medical insurance through Providence Health Plan
- Infusion Therapy Site of Care Policy and Drug List (PDF)
- Approved Site of Care Facility List (PDF)
- Site of Care Prior Authorization Request Form (PDF)
Self-Administered Drug Exclusion Policy – Commercial and Medicaid Members
Self-Administered Drug definition - Medications which have been identified as being medically appropriate for administration by a patient or caregiver, safely and effectively, without medical supervision.
Certain medications considered to be usually self-administered by the patient or their caregiver are excluded from coverage under the medical benefit without prior-authorization.
Additional member resources
- Formulary updates (PDF)
A summary of upcoming changes to your formulary - Coverage of Affordable Care Act (ACA) preventive drugs (PDF)
Information about which preventive drugs are covered without imposing a copayment, coinsurance or deductible. - Emergency Prescription Fills (PDF)
Information for emergency prescriptions fills for Washington Commercial members only. - Prescription Drug Reimbursement
Prescription drug reimbursement is subject to plan benefits, limitations and exclusions at the time the prescription was filled. Most plan benefits require use of a participating pharmacy. Services are eligible for reimbursement only if a Providence Health Plan participating pharmacy was not available or accessible (e.g., emergencies). To request reimbursement for prescription drugs, fill out the prescription drug reimbursement request form (PDF) and submit it, along with a copy of your itemized receipt, to the address indicated on the form. Keep a copy of the completed form and a copy of your receipt for your records.
Please note: this form may also be used to request reimbursement for over-the-counter contraceptives.
Having trouble finding something?
Visit our pharmacy FAQ page for more answers to commonly asked questions or contact our customer service team and we will be happy to help you find the answers you need.
Pharmacy FAQ