A formulary (also called a covered drug list) is a list of prescription drugs your plan covers. These are the medications your plan helps pay for. This list is created with the help of doctors and pharmacists and follows Medicare guidelines to ensure the medications are safe and effective. The list includes both brand-name and generic medications. Generic medications have the same active ingredients and work the same way as brand-name drugs, but they usually cost less. When a generic is available, we typically cover the generic to help keep your costs lower. Some medications on the list of covered medications may have rules or limits on how they are covered. These may include: 

Getting approval before certain medications are covered

Some medication rules say your provider must ask for approval before the medication is covered. This is called a prior authorization. Prior authorizations help ensure the medication is safe and appropriate for your condition before you receive it. Your provider will request this approval for you.

Trying a lower-cost option first

Some medication rules may require you to try safe, lower-cost options (such as generic medications) first. This is because these medications work in a similar way and are just as effective for your condition as a higher-cost medication. This is called step therapy. If it does not work for you, your provider can request a different option.

Limits on how much medication you can receive

For safety reasons, some medications have limits on how much you can get at one time—for example, one pill per day if that is the safe amount. This is called a quantity limit. These limits are based on doses that are known to be safe and effective and help prevent possible harm. Please note that if you see the same drug more than once on your drug list, it is because there may be different limits or costs that apply for different strengths (such as 10mg verse 100mg), different amounts, or different formulations (such as liquid vs. capsule). 

Use the online formulary search tool below to see if a Part D medication is covered and any rules or limits that apply.

Get help or request a copy 

• Call 503-574-8000 or 1-800-603-2340 (TTY: 711)
• Request a mailed copy using this link

Customer Service hours  

• October 1 – December 31: 8 a.m. – 8 p.m. (Pacific Time), 7 days a week
• January 1, 2027 - December 31, 2027: 8 a.m. – 8 p.m. (Pacific Time), Monday – Friday
  

Some Medicare Part B drugs may have coverage requirements, such as step therapy or prior authorization.

Step Therapy: You may need to try certain drugs before another drug will be covered.

• View the 2026 Step Therapy Drug List for Medicare Part B

Prior Authorization: You (or your provider) may need approval before the drug will be covered.

• View the 2026 Prior Authorization Criteria for Medicare Part B Drugs
  

• Providence Medicare Advantage Plans Prime + Rx (HMO), Extra + Rx (HMO), Pine + Rx (HMO), Timber + Rx (HMO)
• Providence Medicare Advantage Plans Sycamore + Rx (HMO)
• Providence Medicare Dual Plus (HMO D-SNP)
• Providence Medicare Group Plans
  + ALIGN GROUP PLAN + RX (HMO) 15/30 AND ALIGN GROUP PLAN + RX (HMO) 10/50/1000 
  + PHIP ALIGN GROUP PLAN + RX (HMO) AND PHIP FLEX GROUP PLAN + RX (HMO-POS)
  + ALIGN DISCOVER GROUP PLAN + RX (HMO), ALIGN EXPLORE GROUP PLAN + RX (HMO), AND DISCOVER GROUP PLAN + RX (HMO-POS)

If you are new to our plan, you may be taking a medication that is not on our list of covered medications or has certain rules, such as prior authorization, step therapy, or quantity limits. 

To help make your transition easier, we will cover a temporary supply of your medication when you fill your prescription at a network pharmacy. This is usually up to a 30-day supply (or multiple fills that total up to 30 days if your prescription is for fewer days).

This temporary supply gives you time to talk with your provider about your options. After this temporary supply, your medication may need to meet plan requirements, such as getting approval or switching to a covered medication.

What should you do next?
Talk with your provider to decide if you should:

• Switch to a medication that is covered by your plan, or
• Ask us to cover your current medication if it is needed for your condition

Some types of medications are not covered by Medicare Part D. Because of this, these medications will not be covered, even during your transition period.

Examples of medications that are not covered include:

• Over-the-counter medications (drugs you can buy without a prescription)
• Medications used to help with fertility
• Medications for cough and cold symptoms
• Medications used for cosmetic purposes, such as hair growth
• Most prescription vitamins and minerals (except prenatal vitamins and fluoride)
• Medications for sexual or erectile dysfunction (such as Viagra, Cialis, Levitra, and Caverject)
• Medications used for weight loss, weight gain, or appetite control
• Certain medications that require you to purchase related testing or monitoring services only from the manufacturer

If you are taking one of these medications, talk with your provider about other treatment options that may be covered by your plan.

If you live in a long-term care facility, we will cover a temporary supply of your medication to help ensure you do not have a gap in treatment. This is usually up to a 31-day supply (or less if your prescription is written for fewer days).

During your first 90 days as a member, we may provide more than one refill of this temporary supply, if needed.

If you are past your first 90 days and still need a medication that is not on our list of covered medications or has rules (such as step therapy), we will provide a one-time emergency supply of up to 31 days (or less if your prescription is for fewer days).

This temporary supply gives you time to talk with your provider about your options, such as switching to a covered medication or asking us to cover your current medication.

Each year, changes to your plan’s list of covered medications may affect the medications you take. A medication may no longer be covered, or it may have new rules, such as needing approval before it is covered. If this happens, you have options. You can talk with your provider about switching to a medication that is covered by your plan, or your provider can ask us to cover your current medication if it is needed for your condition.

If you need help, please contact Customer Service:

• Call 503-574-8000 or 1-800-603-2340
• TTY users can call 711

Customer Service hours:

• October 1 through March 31: 8 a.m. to 8 p.m. (Pacific Time), 7 days a week
• April 1 through September 30: 8 a.m. to 8 p.m. (Pacific Time), Monday - Friday 

Extra Help, also known as a Part D Low-Income Subsidy, or LIS, is a federal program that helps lower prescription costs and Part D (prescription) costs for Medicare Advantage members. Learn more about Extra Help by connecting with one of our team members who can help walk you through how the program works.

Call: 503-574-8416 (TTY: 711) 8 a.m. to 5 p.m. (Pacific Time) Monday - Friday

Learn more about Extra Help or apply online here.

2026 Subsidized Premium Table (PDF)
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The Medicare Prescription Payment Plan lets you spread your out-of-pocket prescription drug costs over the calendar year (January–December) instead of paying all at once. This option may not be right for everyone. For example, it may not be a good fit if your yearly drug costs are low or if you receive Extra Help.

Learn more or sign up:

• Visit the CapitalRx online portal
• Call CapitalRx at 1-855-742-2779 (TTY: 711), available 24 hours a day, 7 days a week
  

You can also learn more about:

• Who may benefit
• Program rules
• How to sign up
• Monthly payment examples
• How to file a complaint or grievance
  

Anyone with a Medicare drug plan or Medicare health plan with drug coverage (like a Medicare Advantage Plan with drug coverage) can use this payment option for drugs covered by Part D.

If you select this payment option, each month you’ll continue to pay your plan premium (if you have one), and you’ll get a bill from Providence Medicare Advantage Plans to pay for your prescription drugs (instead of paying the pharmacy). All of our Part D plans offer this payment option, and participation is voluntary. It doesn’t cost anything to participate in the Medicare Prescription Payment Plan, and you won’t pay any interest or fees on the amount you owe, even if your payment is late. 

Medicare Prescription Payment Plan Fact Sheet

English | Spanish | Vietnamese | Russian | Simplified Chinese | Arabic | Somali

If you have high out-of-pocket drug costs, this payment option spreads out what you’ll pay each month across the calendar year (Jan – Dec), so you don’t have to pay out-of-pocket costs to the pharmacy. This payment option might help you manage your expenses, but it doesn’t save you money or lower your drug costs.

This payment option might not be the best choice for you if:

• Your yearly drug costs are low
• Your drug costs are the same each month
• You’re considering signing up for the payment option late in the calendar year (after September)
• You don’t want to change how you pay for your drugs
• You get or are eligible for Extra Help from Medicare
• You get or are eligible for a Medicare Savings Program
• You get help paying for your drugs from other organizations, like a State Pharmaceutical Assistance Program (SPAP) or a charity

The program is free to join, there are no fees or interest charged under the program, the program does not reduce the amount of cost-sharing a participant owes for their prescriptions.

Your out-of-pocket costs in 2027 are capped at $2,400. This means that you'll never pay more than $2,400 in out-of-pocket costs in 2027. This is true for everyone with Medicare Part D drug coverage, even if you don't join the Medicare Prescription Payment Plan.

If you miss paying a monthly payment, Providence Medicare Advantage Plans will reach out to let you know. We will provide your missed due date, the amount you owe, and the date for the end of the grace period. The grace period is 2 months.

If you do not pay before the end of the grace period, you will be removed from the program and will be required to pay your full copay amount when you pick up your prescription at the pharmacy. You will still be required to pay the amount you owe, but will not pay any interest or fees.

Fill out the Election Form and mail, email or fax it in:

Election Form 

English | Spanish | Vietnamese | Arabic | Chinese | Russian | Somali

On the CapitalRx Online Portal

Call the Customer Care Phone Service at 1-855-742-2779 (TTY: 711) 24 hours a day, 7 days a week

We will send a notice when you are active in the Medicare Prescription Payment Plan. Until then you will need to continue to pay at the pharmacy.

You take several high-cost drugs that have a total out-of-pocket cost of $500 each month. In January 2026, you join the Medicare Prescription Payment Plan through your Medicare drug plan or Medicare health plan with drug coverage.

We calculate your first month’s bill in the Medicare Prescription Payment Plan differently than your bill for the rest of the months in the year:

First, we figure out your “maximum possible payment” for the first month: 
$2,100 [annual out-of-pocket maximum] – $0 [no out-of-pocket costs before using this payment option] = $2,100. Then divide that by 12 [remaining months in the year] = $175 “maximum possible payment”

Then, we figure out what you’ll pay for January:

• Compare your total out-of-pocket costs for January ($500) to the “maximum possible payment” we just calculated: $175.
• Your plan will bill you the lesser of the two amounts. So, you’ll pay $175 for the month of January.
• You have a remaining balance of $325 ($500-$175).

For February and the rest of the months left in the year, we calculate your payment differently: 
$325 [remaining balance] + $500 [new costs] = $825. Then divide by 11 [remaining months in the year] = $75 for your payment in February.

We’ll calculate your March payment like we did for February: 
$750 [remaining balance] + $500 [new costs] = $1,250. Then divide by 10 [remaining months in the year] = $125 for your payment in March.

We’ll calculate your April payment like we did for March: $1,125 [remaining balance] + $500 [new costs] = $1,620. Then divide by 9 [remaining months in the year] = $180.55 for your payment in April.

In May, when you refill your prescriptions again, you’ll reach the annual out-of-pocket maximum for the year ($2,100 in 2026). You’ll continue to pay what you already owe and get your prescription(s), but after May you won’t add any new out-of-pocket costs for the rest of the year.

$1,544.45 [remaining balance]. Then divide by 9 [remaining months in the year] = $171.60 for your payment for May.

Even though your payment varies each month, by the end of the year, you’ll never pay more than:

• The total amount you would have paid out-of-pocket. 
• The total annual out-of-pocket maximum ($2,100 in 2026).

Remember, this is just your monthly payment for your out-of-pocket drug costs. You still need to pay your health or drug plan’s premium (if you have one) each month.

If you believe that any delay in filling the prescription(s) may seriously jeopardize your life, health, or ability to regain maximum function, Providence Medicare Advantage Plans must process an urgent retroactive election request when you inquire within 72 hours of the date and time the urgent claim(s) were decided.

File a complaint or grievance here.

Need Extra Help paying for your prescriptions? Extra Help is a federal program that is available for Medicare eligible individuals in the U.S. who are age 63 and over and meet income requirements. Extra Help lowers prescription drug costs and the Part D premium to $0, in most cases resulting in a $0 monthly premium.

Learn more