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.

Finding 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. Your provider may use the drug prior authorization form for this exception request.

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 Benefit Drug Prior Authorization List (PDF) 

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 and submit to the health plan.

• Drug prior authorization form (PDF)
• Uniform prior authorization prescription request form (PDF)
• Providence Health Plan drug coverage prior authorization form (secure email)

Infusion Therapy Site of Care Policy – Commercial Members (Individual, Small Group and Large Group Plans)

Providence Health Plan (PHP) requires site of care prior authorization for the drugs listed below when given in an unapproved hospital setting. A separate prior authorization may be required for the drug.

• Approved Site of Care List (PDF)

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.

Participating pharmacies

You have access to more than 36,000 participating pharmacy locations nationwide.

Retail 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.

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 – Friday, 8 a.m. to 6 p.m. (Pacific Time).

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.