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.
Pharmacy Resource Flyer Pharmacy Resource Flyer (Spanish)
Formulary
List of prescription drugs covered under your plan
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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
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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:
- Complete the online Providence Health Plan drug coverage prior authorization form
- Your provider may use the drug prior authorization form and submit the exception request to the health plan
- 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:
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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:
- Formulary updates (PDF)
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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.
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I have an Individual & Family plan
Plan
2025 Formulary
Prescription drug coverage effective on or after January 1, 2025.
2026 Formulary
Prescription drug coverage effective on or after January 1, 2026.
Connect (OR)
Standard (OR)
Providence Oregon Direct (OR)
Formulary N Formulary N (Coming soon) HSA (OR) Formulary N-HSA Formulary N-HSA (Coming soon) Columbia (WA) Formulary M Formulary M (Coming soon)
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I have a Medicare or Medicaid plan
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I have a Small Group employer plan
Plan
2025 Formulary
Prescription drug coverage effective on or after January 1, 2025.
2026 Formulary
Prescription drug coverage effective on or after January 1, 2026.
Balance
Choice
Connect
Standard
Total Enhanced
Formulary P Formulary P (Coming soon) HSA Formulary P-HSA Formulary P-HSA (Coming soon)
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I have a Large Group employer plan
Plan
Pharmacy Plan
2025 Formulary
Prescription drug coverage effective on or after January 1, 2025.
2026 Formulary
Prescription drug coverage effective on or after January 1, 2026.
Choice
Connect
Option Advantage Base
Option Advantage Plus (A)
Option Advantage Premium (B)
Out of Area
Personal Option
Traditional Option6 Tier Plan
Formulary P Formulary P (Coming soon) 2 Tier Plan
Formulary A Formulary A (Coming soon) Value Plan
Value Plan
Formulary D Formulary D (Coming soon) HSA
HSA Qualified Plans with Core Preventive (6-Tier)
Formulary P-HSA Formulary P-HSA (Coming soon)
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I have coverage through my employer
2025 Formulary
Prescription drug coverage effective on or after January 1, 2025.
2026 Formulary
Prescription drug coverage effective on or after January 1, 2026.
Formulary A Formulary A (Coming soon) Formulary B Formulary B (Coming soon) Formulary B - Preventive Formulary B - Preventive (Coming soon) Formulary B - Harrison Formulary B - Harrison (Coming soon) Formulary C Formulary C (Coming soon) Formulary D Formulary D (Coming soon) Formulary F Formulary F (Coming soon) Formulary J Formulary J (Coming soon) Formulary K Formulary K (Coming soon) Formulary L Formulary L (Coming soon) Formulary P Formulary P (Coming soon) Formulary P-HSA Formulary P-HSA (Coming soon)
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
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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.
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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.
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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:
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.
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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.
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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
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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.
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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.
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 OHPIf 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:
- Exactcare – Click the Get Started button on their website or call: 877-355-7225
- SelectRx – Click the Get Started button on their website or call: 833-307-1517
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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:
- Exactcare - Click the Get Started button on their website or call: 877-355-7225
- SelectRX - Click the Get Started button on their website or call: 833-307-1517
Programs available to maximize cost savings
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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.
Visit myrxss.com/ProvidenceHealthPlan to set up your account.
Visit myrxss.com/ASO/ProvidenceHealthPlan to set up your account.
For assistance, call 800-268-4476 (TTY 800-877-8973), Monday-Friday, 5 a.m. to 6 p.m. (Pacific Time).
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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.
- Infusion Therapy Site of Care Policy and Drug List (PDF)
- Approved Site of Care Facility List (PDF)
- Site of Care Prior Authorization Request Form (PDF)
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
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Coverage of Affordable Care Act ACA preventive drugs
- Coverage of Affordable Care Act (ACA) preventive drugs (PDF)
Information about which preventive drugs are covered without imposing a copayment, coinsurance or deductible.
- Coverage of Affordable Care Act (ACA) preventive drugs (PDF)
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Emergency prescription fills
- Emergency Prescription Fills (PDF)
Information for emergency prescriptions fills for Washington Commercial members only.
- Emergency Prescription Fills (PDF)
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Prescription drug reimbursement
- Prescription Drug Reimbursement
Prescription drug reimbursement is subject to plan benefits, limitations and exclusions at the time the prescription was filled. Most plan benefits require use of a participating pharmacy. Services are eligible for reimbursement only if a Providence Health Plan participating pharmacy was not available or accessible (e.g., emergencies). To request reimbursement for prescription drugs, fill out the prescription drug reimbursement request form (PDF) and submit it, along with a copy of your itemized receipt, to the address indicated on the form. Keep a copy of the completed form and a copy of your receipt for your records.
Please note: This form may also be used to request reimbursement for over-the-counter contraceptives.
- Prescription Drug Reimbursement
Have questions?
Visit our Pharmacy FAQ page for more answers to commonly asked questions or contact our customer service team.
Pharmacy FAQ