Pharmacy resources
Providence Health Plan is pleased to provide plan members with a comprehensive prescription drug formulary designed to promote safe, effective, and affordable drug therapy.
Your formulary is easy to search, includes information about the medication, and includes special considerations about the prescription, if they apply.
Finding and searching your formulary
Find your medical plan below by first selecting the type of health plan you have to determine which formulary applies to you and your plan. Once selected, you can search your online formulary for the prescriptions you are inquiring about.
Tip: There may be times when you require a medication 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.
What kind of health plan do you have?
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I have an individual or family plan
2021 Product
Medical Plan
Formulary
Connect (OR) Connect 1500 Silver
Connect 4500 Silver
Connect 8550 Bronze2021 Formulary N Standard (OR) Standard Gold
Standard Silver
Standard Bronze
HSA (OR) HSA 6750 Bronze 2021 Formulary N-HSA Columbia (WA)
Columbia 1500 Gold
Columbia 4500 Silver
Columbia 8550 Bronze2021 Formulary M
Cascade (WA) Cascade Gold
Cascade Silver
Cascade Bronze2021 Formulary M -
I have a Medicare or Medicaid plan
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I have a small group employer plan
Prescription drug coverage effective on or after Jan. 1, 2021
2021 Product
Medical Plan
Formulary
Balance Balance 750 Gold
Balance 1500 Gold
Balance 2500 Silver
Balance 3500 Silver
Balance 4500 Silver
Balance 6000 Silver
Balance 7000 Bronze
Balance 8550 Bronze2021 Formulary P Choice Choice 750 Gold
Choice 1500 Gold
Choice 2800 Silver
Choice 3500 Silver
Choice 4500 Silver
Choice 6000 Silver
Choice 7000 Bronze
Choice 8550 Bronze
Connect Connect 750 Gold
Connect 1500 Gold
Connect 2800 Silver
Connect 3500 Silver
Connect 4500 Silver
Connect 6000 Silver
Connect 7000 Bronze
Connect 8550 Bronze
Standard Standard Gold
Standard Silver
Standard Bronze
Total Enhanced Total Enhanced 250 Platinum
Total Enhanced 500 Platinum
Total Enhanced 1000 Gold
Total Enhanced 1500 Gold
Total Enhanced 2500 Gold
Total Enhanced 3500 Gold
Total Enhanced 4500 Gold
Total Enhanced 5500 Gold
Total Enhanced 7200 Silver
HSA HSA 1500 Gold
HSA 2500 Silver
HSA 3500 Silver
HSA 4500 Bronze
HSA 5500 Bronze
HSA 6750 Bronze
2021 Providence Formulary P-HSA
Prescription drug coverage effective on or after Jan. 1, 2020
2020 Product
Medical Plan
Formulary
Balance Balance 750 Gold
Balance 1500 Gold
Balance 2500 Silver
Balance 3500 Silver
Balance 4500 Silver
Balance 6000 Silver
Balance 7000 Bronze
Balance 7900 Bronze
Balance 8150 Bronze2020 Providence Formulary J
Connect Connect 750 Gold
Connect 1500 Gold
Connect 2500 Silver
Connect 3500 Silver
Connect 4500 Silver
Connect 6000 Silver
Connect 7000 Bronze
Connect 7900 Bronze
Connect 8150 BronzeStandard Standard Gold
Standard Silver
Standard Bronze
Total Enhanced Total Enhanced 250 Platinum
Total Enhanced 500 Platinum
Total Enhanced 1000 Gold
Total Enhanced 1500 Gold
Total Enhanced 2500 Gold
Total Enhanced 3500 Gold
Total Enhanced 4500 Gold
Total Enhanced 5500 Gold
Total Enhanced 7000 Silver
HSA HSA 1700 Silver
HSA 2500 Silver
HSA 3000 Silver
HSA 3500 Silver
HSA 4500 Bronze
HSA 5500 Bronze
HSA 6650 Bronze
HSA 6750 Bronze2020 Providence Formulary K -
I have a large group employer plan
Prescription drug coverage effective on or after Jan. 1, 2021
2021 Product
Rx Plans
Formulary
Choice
Connect
Option Advantage Base
Option Advantage Plus (A)
Option Advantage Premium (B)
Out of Area
Personal Option
Traditional OptionRx $10/$15/$30/$60/50%
Rx $10/$15/$45/$75/50%
Rx $10/$15/$60/$80/50%
Rx $10/$20/$75/$100/50%
Rx $10/$15/$30/$30/$302021 Providence Formulary P Rx $15/$30 | rXtra $15/$30
Rx $15/$45
Rx $15/50%2021 Providence Formulary A Value Plan
Rx $5/$10/$50/50%
Rx $5/$15/$30/50%
Rx $5/$15/$40/50%2021 Providence Formulary D HSA (Aggregate & Embedded)
HSA Qualified Plans with Safe Harbor (6-tier)
2021 Providence Formulary P-HSA HSA Connect (Aggregate & Embedded)
HSA Qualified Plans with Safe Harbor (6-tier)
2021 Providence Formulary P-HSA
Prescription drug coverage effective on or after Jan. 1, 2020
2020 Product
Rx Plans
Formulary
Choice
Connect
Option Advantage Base
Option Advantage Plus (A)
Option Advantage Premium (B)
Out of Area
Personal Option
Traditional OptionRx $10/$15/$30/$60/50%
2020 Providence Formulary B
Rx $10/$15/$45/$75/50%
Rx $10/$15/$60/$80/50%
Rx $15/$15/$30/$30/$30
Rx $15/$15/$45/$45/$45
Rx $15/$20/50%/50%/50%
Rx $15/$20/$75/$100/50%
Rx $15/$30 | rXtra $15/$30 2020 Providence Formulary A
Rx $15/$45 Rx $15/50% | rXtra $15/50%
Value Plan Rx $5/$10/$50/50%
2020 Providence Formulary D
Rx $5/$15/$30/50%
Rx $5/$15/$40/50%
HSA (Aggregate & Embedded)
HSA Connect (Aggregate & Embedded)HSA Qualified Plans (5-tier) 2020 Providence Formulary B
HSA Qualified Plans with Safe Harbor (5-tier) 2020 Providence Formulary F
If you are employed by one of the following, select your formulary here:
- Columbia Sportswear CDHP members: 2020 formulary; 2021 formulary
- Columbia Sportswear Option Advantage members: 2020 formulary; 2021 formulary
- Harrison Electrical Workers Trust 2020 formulary; 2021 formulary
- Intel: 2020 formulary; 2021 formulary
- PEBB: 2020 formulary; 2021 formulary
- PGE – HSA plan members: 2020 formulary; 2021 formulary
- PGE – All other PGE plan members: 2020 formulary; 2021 formulary
- Providence Health & Services 2020 formulary; 2021 formulary
Medical benefit drug authorization
The following list is intended to provide guidance regarding coverage of healthcare services and are 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.
Drug prior authorization forms:
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 medications listed below when given in an unapproved hospital setting. A separate prior authorization may be required for the drug.
Additional member resources
- Formulary updates (PDF)
- Coverage of Affordable Care Act (ACA) preventive prescription medications (PDF)
Information about which preventive medications Providence Health Plan covers without imposing a copayment, coinsurance or deductible.
Participating pharmacies
You have access to more than 36,000 participating pharmacy locations nationwide.
Find a pharmacyRetail pharmacy
A retail pharmacy can provide up to a 30-day supply of prescription medications. 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 medications. 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 medications and specializes in direct delivery to your home.
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Costco Home Delivery
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, your network provisions may require the use of just one mail order pharmacy for coverage. Please call the Providence Health Plan Pharmacy Department at 877-216-3644 if you have questions.
Order prescriptions by mail
- Register with Costco Home Delivery online at www.costco.com/Pharmacy/home-delivery
- Costco pharmacy agents are available at 800-607-6861 (Mon – Fri 5 a.m. to 7 p.m. PT, Sat 9:30 a.m. to 2 p.m. PT)
- 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
Mon – Fri 5 a.m. to 7 p.m. PT, Sat 9:30 a.m. to 2 p.m. PT
Pharmacy is available 24/7 to refill prescriptions, order new prescriptions and check prescription status.
Phone:
Fax:
Mailing address:
802 134th St. SW Ste 140, Everett, WA 98204-7314
Contact Costco Home Delivery Pharmacy 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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Postal Prescription Services
As a Providence Health Plan member, you have access to full-service mail-order 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. Postal Prescription Services will verify your eligibility when you register.
Your network provisions may require the use of just one of these mail-order pharmacies for coverage. Please call the Providence Health Plan Pharmacy Department at 877-216-3644 if you have questions.
Order prescriptions by mail
- Download this guide to creating an account with Postal Prescription Services online at www.ppsrx.com or call 503-797-2100 or 800-552-6694 (Mon – Fri 6 a.m. to 6 p.m. PT, Sat 9 a.m. to 2 p.m. PT)
- Order or refill your prescription online, or call 800-552-6694 – available 24/7, 365 days a year
- Your doctor may also fax in new or refill orders at 800-723-9023
- Refer to your prescription drug benefit summary for plan details
Questions?
Contact Postal Prescription Services at:
Website:
Phone:
Mon – Fri 6 a.m. to 6 p.m. PT, Sat 9 a.m. to 2 p.m. PT
Mailing address:
PO Box 2718, Portland, OR 97208
Automated refill line available 24/7, 365 days a year:
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
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 medications 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.
Pharmacy FAQ