Pharmacy FAQ

The following addresses many common questions about prescription drug coverage and provides information to help you make the most of your plan benefits.

Pharmacy benefits and prescription drug coverage

Participating pharmacies


  • What is a formulary?

    A formulary is a list of Food and Drug Administration-approved prescription generic, brand-name and specialty medications. The formulary can be a useful resource in helping you and your physician choose effective medications that minimize your out-of-pocket expense. The formulary contains more than 2,500 drug-strength-dosage combinations and is externally audited every year to assure completeness. Once doctors become familiar with the formulary, more than 95 percent of the time they treat medical conditions with a formulary drug and more than 80 percent of the time they choose a generic drug.

  • Which formulary applies to me?

    Review your plan's formulary here. You can also find a list of Providence Health Plan plan formularies by visiting our pharmacy resources webpage.

    If you need assistance determining which plan formulary applies to you, please call Providence Health Plan pharmacy customer service at 503-574-7400 or 877-216-3644.

  • How do I search the formulary?

    There are three ways to search the formulary:

    1. By medical condition category: The first section of the formulary lists prescription drugs by the medical condition category that the drug treats (e.g., drugs used to treat heart conditions are listed under the category, Cardiovascular Agents).

    2. By searching the index: The index provides an alphabetical listing of the drugs included in the formulary.

    3. By using the "find" feature: When seeking a specific drug by name, you may use the "find" box at the top of the page.

  • What if my drug is not on the formulary?

    Non-formulary drugs may be eligible for coverage. If your drug is not included on the formulary, you can identify similar drugs on the formulary by searching the medical condition category or you can call the pharmacy department for help finding a therapeutically interchangeable formulary alternative at 503-574-7400. If there are no appropriate formulary alternatives, your prescribing provider can request an exception by submitting supporting documentation via a prior authorization request.

  • How does my doctor know which medications are on my formulary?

    Your formulary is available to your doctor via the Providence Health Plan website as well as through other electronic and online resources frequently used by your doctor's office.

  • How do drugs get selected for the formulary?

    The formulary is developed by the Pharmacy and Therapeutics Committee, which is composed of doctors and pharmacists who review prescription drugs based on safety, effectiveness, cost and Food and Drug Administration approval. The committee reviews the latest evidence to identify opportunities to promote safe, effective and affordable drug therapy.

  • Does the formulary change?

    Yes. The formulary is updated every two months. Generally, formulary status for a formulary drug you are taking with your Providence Health Plan pharmacy benefit will not change during the year unless:


    1. The same medication is now available in generic form (the generic form will be covered), or

    2. Safety or effectiveness concerns are raised about the prescription drug.


    If a formulary change results in a reduction of benefits or an increase in copayment, impacted individuals are always notified in writing at least 60 days before any change.

Prior Authorization

Generic Drugs

  • What is a generic drug?

    Generic drugs have the same active ingredient as equivalent brand-name drugs. Generic drugs are determined by the Food and Drug Administration to be as safe and as effective as brand-name drugs. Generic drugs are only available after the brand-name patent expires. The bonus: They save you money.

  • Are brand-name and generic drugs equivalent?

    A generic drug is equivalent to the brand-name drug with the same active ingredient, dosage form, and strength. The FDA assures equivalence between the brand-name and generic products. Generic drugs cost less than brand-name products. For example, for high cholesterol, Lipitor® is now available in generic form from multiple manufacturers under the generic name atorvastatin. Lipitor® and atorvastatin are identical drugs — the only difference is one is a brand-name, the other is generic and costs much less.

  • My drug does not have a generic equivalent. Is there a generic alternative?

    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.

  • How do I find a generic alternative for my brand-name medication?

    Search the formulary by medical condition category and look for a medication classified as generic.
    Visit the Consumer Reports Best Buy Drug website, which has information regarding safe and effective drug use by medical condition.

  • Where can I find more information about generics?

Specialty Medications

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