Pharmacy resources

Providence Health Plan is committed to helping you manage your prescriptions. Here you’ll learn about your pharmacy benefits. From finding in-network pharmacies, how to get prescriptions by mail, to understanding which drugs are covered by your plan, and how to get your prescriptions filled.

We want to ensure you have the resources to make the most out of your plan benefits, so you can save time and money when getting the prescriptions you need.

 

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Formulary


List of prescription drugs covered under your plan
  • Plan formulary

    A formulary is a list of drugs that are covered by your plan. The formulary includes drugs that are dispensed by a pharmacy and self-administered.


    Developed in collaboration with our Pharmacy & Therapeutics Committee (a medical committee consisting of a variety of practicing physicians, nurses, and pharmacists), the formulary includes FDA-approved prescription generic, brand-name and specialty drugs that are considered effective and safe for use for a variety of conditions.


    • Generic drugs, which are available only after the brand-name patent expires:
      • Have the same active ingredient formula as the brand-name drug, and
      • Tested by the Food and Drug Administration (FDA) to be as safe and effective as the brand-name drug

    • Brand-name drugs are those that are sold under a specific name or trademark by the company that originally received FDA approval. These drugs are protected by patents and typically cost more than generic drugs
    • Specialty drugs are those that require special delivery, handling, administration, and monitoring by a pharmacist. These drugs are listed in the Providence formulary with a status of “Specialty Drug,” and are only available through specialty pharmacies. These drugs are typically limited to a 30-day supply
  • Requesting authorization for drugs not listed in the formulary

    There may be times when you require a drug that is not on the formulary. You or your provider may request an exception be made to cover this medication for you. There are two ways you, your representative, or provider can initiate a prior authorization request:


    1. Complete the online Providence Health Plan drug coverage prior authorization form
    2. Your provider may use the drug prior authorization form and submit the exception request to the health plan
    3. Your provider may use the uniform drug prior authorization prescription request form and submit the exception request to Providence Health Plan

    Learn more about prior authorization in simple terms:


  • Formulary updates

    The formulary is updated monthly with decisions made by our Pharmacy & Therapeutics Committee. This committee is made up of a variety of practicing physicians, nurses, and pharmacists that review the evidence for safety and effectiveness of medications. Coverage of medications may change based on review of new information. You will always be notified in advance if a change will affect your coverage. You can access a summary of upcoming changes to your formulary:


  • 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.

View your formulary


Log into your myProvidence account and go to "My Health Tools," then choose "Pharmacy Information" to view your formulary.


You can also find your formulary or plan formulary below by selecting your health plan type and clicking the link for your plan. Search for the medications you take to learn about coverage, including the tier they're on and any quantity limitations or prior authorizations needed.

Need drug formulary assistance?

Call Pharmacy Customer Service at 503-574-7400 or 877-216-3644 (TTY: 711), Monday Through Friday, 8 a.m. to 5 p.m. (Pacific Time).

Participating pharmacies


Our preferred retail pharmacy network allows members to save time and money when getting prescription drugs. With this network, members have access to more than 34,000 participating pharmacy locations nationwide.



Find a pharmacy
  • Preferred retail pharmacy

    A preferred retail pharmacy can provide up to a 90-day supply of prescription drugs.


    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.


    Search the pharmacy directory for a pharmacy near you. 

  • Retail pharmacy

    A retail pharmacy can provide up to a 30-day supply of prescription drugs.


    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.


    Search the pharmacy directory for a pharmacy near you.

     
  • Mail-order pharmacy: Costco Home Delivery

    A mail-order pharmacy can provide up to a 90-day supply of maintenance drugs and specializes in direct delivery to your home.


    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, Costco membership is not required to use the mail order pharmacy.


    Have questions? Call Pharmacy Customer Service at 503-574-7400 or 877-216-3644 (TTY: 711), Monday through Friday, 8 a.m. to 5 p.m. (Pacific Time).



    Order prescriptions by mail
    • Use this guide to help in creating an account with Costco Home Delivery online at Rx.Costco.com
    • Costco pharmacy agents are available at 800-607-6861, Monday through Friday, 5 a.m. to 7 p.m. (Pacific Time); Saturday, 9:30 a.m. to 2 p.m. (Pacific Time)
    • 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

    Costco Home Delivery Pharmacy is available Monday through Friday, 5 a.m. to 7 p.m. (Pacific Time); Saturday, 9:30 a.m. to 2 p.m. (Pacific Time).


    Costco Home Delivery Pharmacy is available 24/7 to refill prescriptions, order new prescriptions and check prescription status.


    Call 800-607-6861


    Fax: 800-633-0334


    Mailing address: 802 134th St. SW Ste 140, Everett, WA 98204-7314


    Email:

    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.

  • Mail-order pharmacy: Postal Prescription Services

    As a Providence Health Plan member, you have access to full-service mail-order prescription services through Postal 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 have access to this mail order pharmacy. Postal Prescription Services will verify your eligibility when you register.


    Have questions? Call Pharmacy Customer Service at 503-574-7400 or 877-216-3644 (TTY: 711), Monday through Friday, 8 a.m. to 5 p.m. (Pacific Time).



    Order prescriptions by mail
    • Use this guide to help create an account with Postal Prescription Services online at PPSRX.com
    • Postal Prescription Service agents are available at 503-797-2100 or 800-552-6694, Monday through Friday, 6 a.m. to 6 p.m. (Pacific Time); Saturday, 9 a.m. to 2 p.m. (Pacific Time)
    • Order or refill your prescription online, or call 800-552-6694
    • Your doctor may also fax in new or refill orders at 800-723-9023
    • Refer to your prescription drug benefit summary for plan details


    PPS contacts, FAQ, and how-to guide


    Contact information

    Postal Prescription Services is available Monday through Friday, 6 a.m. to 6 p.m. (Pacific Time); Saturday, 9 a.m. to 2 p.m. (Pacific Time).


    Phone: 503-797-2100 or 800-552-6694


    Automated refill line available 24/7, 365 days a year: 800-552-6694


    Fax: 800-723-9023


    Online at PPSRX.com


    Mailing address: PO Box 2718, Portland, OR 97208


    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

    A specialty pharmacy provides medications for complex, chronic, or rare medical conditions. These specialty drugs are prescriptions that may require special delivery, handling, administration and/or monitoring by a pharmacist.


    Specialty drugs can be found within your plan formulary, noted by "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).

    With specialty pharmacies, members have access to a specialty care team. This team provides extra support by:


    • Identifying specialty prescriptions available
    • Locating a specialty pharmacy near you
    • Coordinating care between healthcare providers
    • Determining if you are eligible for financial assistance
  • 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.


  • Immunizations and vaccines

    Immunizations and vaccines are important because they help protect us from serious diseases throughout our lives – from infancy to older adulthood. When you get a vaccine, it trains your body to fight off germs without getting sick. This not only keeps you healthy, but it also helps stop the spread of diseases to other people, making the whole community safer.

     

    What Vaccines are Covered?

    Talk to your doctor or pharmacist about the specific needs of you and your family. Here is a list of covered CDC-recommended routine vaccines. Age restrictions or limitations may apply. Check with your participating pharmacy for requirements and availability.


    • COVID-19
    • Hepatitis A and Hepatitis B
    • Herpes Zoster (also known as Shingles)
    • Human Papillomavirus (HPV)
    • Influenza (flu shot) – inhalation or injection
    • Measles, Mumps and Rubella
    • Meningococcal (Meningitis)
    • Pneumococcal (Pneumonia)
    • RSV (Respiratory Syncytial Virus)
    • Tetanus/diphtheria/pertussis
    • Varicella (Chickenpox)

    **Please note: This list is subject to change and can vary by plan. Not all vaccines on this list may be available at all pharmacies. Contact your local participating pharmacy prior to your visit to confirm which vaccines they offer.



    Finding Participating Pharmacies

    Many nationwide chains, regional chains and independent pharmacies contract with Providence Health Plan to administer vaccines to our members.


    To find a participating pharmacy:


    • Visit the online Provider Directory. You can search by your member ID or provider network. Choose “Find a Service or Place” and click “Pharmacies.”
    • Select Find a Pharmacy, enter your zip code and select the type of pharmacy you are looking for.
    • Look for a pharmacy that offers “Vaccination Services” in your network.

    You may also call the number listed on your Providence Health Plan member ID card for help in finding a participating pharmacy that can provide vaccinations near you.



    Before You Go to the Pharmacy

    Call the pharmacy of your choice for complete details and confirm:


    • The pharmacy’s participation in Providence Health Plan’s Immunization Program.
    • The vaccine is in stock.
    • If you can just walk in or if you need to schedule an appointment.

    *Remember to bring your Providence Health Plan member ID card with you so they can confirm your insurance.



    What do Members Pay?

    Members may have a $0 co-pay at in-network pharmacies for vaccines. Those vaccines must be eligible under the Patient Protection and Affordable Care Act (ACA) which may be subject to restrictions based on the Advisory Committee on Immunization Practices (ACIP) recommendations.


    You can also check your plan materials or call the number listed on your member ID card to get specifics on what your plan covers.



    Medicaid OHP

    If you’re a Medicaid (OHP) member, visit https://www.healthshareoregon.org/members/vaccines for more information.



    Customized Dose Packaging

    Simplify Your Medication Routine with Customized Dose Packaging


    Personalized dose packaging is designed to make managing your medications easier and more convenient. Each package contains presorted, sealed pouches organized by the time of day—morning, afternoon, evening, or bedtime—ensuring you take the right medication at the right time, every time. This eliminates the hassle of daily or weekly pill containers.


    For added convenience, this packaging service is available through our home delivery pharmacies. If you’re taking multiple medications daily, our home delivery options provide this service at no extra cost. Your eligible medications will arrive at your doorstep, with prescription refill dates synchronized to minimize multiple deliveries or trips to the pharmacy.


    To start receiving your medications in customized dose packaging, choose from these Home Delivery pharmacies:


  • Customized dose packaging

    Simplify your medication routine with customized dose packaging.

    Personalized dose packaging is designed to make managing your medications easier and more convenient. Each package contains presorted, sealed pouches organized by the time of day - morning, afternoon, evening, or bedtime - ensuring you take the right medication at the right time, every time. This eliminates the hassle of daily or weekly pill containers.


    For added convenience, this packaging service is available through our home delivery pharmacies. If you're taking multiple medications daily, our home delivery options provide this service at no extra cost. Your eligible medications will arrive at your doorstep, with prescription refill dates synchronized to minimize multiple deliveries or trips to the pharmacy.


    To start receiving your medications in customized dose packaging, choose from these home delivery pharmacies:


Programs available to maximize cost savings

  • Rx Savings Solutions

    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.


    Get started today to see how you can save! 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.

    IMPORTANT NOTE: This program is open to all members of Individual & Family plans. For those with employer-provided health plans, availability is determined on a case-by-case basis and should be coordinated with your Human Resources team. Eligible participants will also receive direct communication from Rx Savings Solutions.


    Your login details are determined by your plan. Please refer to the member ID cards displayed below. Find the card that matches your ID (pay close attention to the specific logo), then use the Rx Savings Solutions portal link provided below.


    Image of a PHP member ID card

    Visit myrxss.com/ProvidenceHealthPlan to set up your account.


    Learn more



    Image of an ASO RxSS card

    Visit myrxss.com/ASO/ProvidenceHealthPlan to set up your account.


    Learn more



    For assistance, call 800-268-4476 (TTY 800-877-8973), Monday-Friday, 5 a.m. to 6 p.m. (Pacific Time).


  • HelpScript (formerly Smart RxAssist)

    HelpScript

    A service that may help you lower your copay cost on certain high-cost medications.


    HelpScript may reduce the out-of-pocket costs of select medications. Eligible members* are enrolled automatically. A specialized patient navigator will assist you every step of the way.


    Service Features and Eligibility 


    • Free to eligible members participating in the HelpScript service.
    • To find the HelpScript Program’s current eligible medications, click the link below. Please note: Medications eligible for the service are subject to change.
    • Because of tax laws regarding a health savings account makes the service unavailable to those enrolled in a Health Savings Account (HSA) medical plan.

    HelpScript Service Eligible Medication List


    *HSA, Medicare and Medicaid plan members, and members 65 years and older are ineligible for the HelpScript Program.

I’m paying 50% to 60% less for my medications now.

Rx Savings Solutions User

Medications Covered Under The Medical Benefit


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.



Infusion Therapy Site of Care

For Individual & Family, and members enrolled in coverage through their employer

Infused drugs are covered under your medical benefit. Providence Health Plan 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.





Self-administered Drug

For Individual & Family, Medicaid, and members enrolled in coverage through their employer

Self-administered drugs are 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

Have questions?

Visit our Pharmacy FAQ page for more answers to commonly asked questions or contact our customer service team.

Pharmacy FAQ
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