Benefits 101

2025 formulary

The formulary is designed to promote safe, effective and affordable drug therapy. Your formulary:

• Allows you to search alphabetically, by entering a portion of the drug name, or by therapeutic class
• Includes additional information about each medication
• Includes special considerations about the prescription, when applicable 

Access your benefit summary to see highlights of plan benefits.

 
2025 Benefit Summary 

Our preferred retail pharmacy network give you access to more than 34,000 participating pharmacy locations nationwide. Refer to the provider directory to find in-network pharmacies near you.

There are four types of in-network pharmacies:

• Retail pharmacy
  Retail pharmacies offer services such as filling up to a 30-day supply of prescription drugs, medication counseling, immunizations, and general health information. Customers can walk in and have their prescriptions filled at a retail pharmacy without the need for an appointment.
• Preferred retail pharmacy
  In most cases, if you choose a preferred retail pharmacy, you will pay less when filling a 30- to 90-day supply of medication. This is because Providence Health Plan has worked with the pharmacy to lower the cost of medication copays for our members.
• Mail-order pharmacy
  Mail-order prescriptions allow you to order up to a 90-day supply of medication and have them delivered to your home, saving you trips to the pharmacy. This excludes specialty and compounded medications.
• Specialty pharmacy
  Specialty medications are used to treat complex health conditions that require education, monitoring, and handling instructions and often require approval before they can be prescribed. To make sure you have the information you need, you’ll have access to a dedicated specialty care team. They’ll provide you with extra support, including where to obtain your specialty medication, and how to get financial assistance (when available).

Learn about how and when to use these pharmacies here.

Rx Savings Solutions

Providence Health Plan partners with Rx Savings Solutions to provide a free, confidential service to help you save money on prescriptions. This new service is linked to your health plan, so everything is personalized for your medications and insurance. Rx Savings Solutions alerts you via mail, email, phone call, or text (if you enroll in SMS messaging) if you have an opportunity to save on your prescription. A team of certified pharmacy technicians and pharmacists help walk you through every step of the process.

Here's how it works:

• Rx Savings Solutions uses software connected to your health plan. It looks at all the medications you take and finds options that may save you money.
• Your online account shows which lower-cost prescriptions may be available under your insurance plan and lets you compare prices. It also automatically lists all medications you’ve filled so everything is in one place.
• Rx Savings Solutions will contact you anytime you can be spending less.
• Switch to a lower-cost option with ease. At your request, the Rx Savings Solutions pharmacy support team is available to work with your doctor and pharmacy to help you switch to lower cost drugs, pharmacies, or mail order pharmacy.

To register for Rx Savings Solutions, visit myrxss.com/ASO/ProvidenceHealthPlan.

For additional support, contact Rx Savings Solutions at 1-800-268-4476 (TTY 1-800-877-8973), Monday-Friday, 5 a.m. to 6 p.m. (Pacific Time).

FAQ

Get answers to many common question about prescription drug coverage and information to help you make the most of your plan benefits.

Pharmacy FAQ 

Learn about coverage of Affordable Care Act (ACA) preventive medications. 

Learn more 

Visit our pharmacy resources page to learn about brand-name and generic drugs, our preferred retail pharmacy network, cost-saving programs, and more.

Go now

• Prescription Drug Reimbursement Request Form (PDF)
• Prescription Drug Prior Authorization Request Form (PDF)
• Prescription Drug Prior Authorization Request Form (secure online form)
• Uniform Prior Authorization Prescription Request Form (PDF)