Self-funded Pharmacy Resources

The formulary is developed by the Pharmacy and Therapeutics Committee, which is composed of doctors and pharmacists who review prescription drugs based on safety, effectiveness, cost and Food and Drug Administration approval. The committee reviews the latest evidence to identify opportunities to promote safe, effective and affordable drug therapy.

The formulary is updated every two months. Generally, formulary status for a formulary drug you are taking with your Providence Health Plan Powered by Collective Health pharmacy benefit will not change during the year unless:

• The same medication is now available in generic form (the generic form will be covered), or
• Safety or effectiveness concerns are raised about the prescription drug.

If a formulary change results in a reduction of benefits or an increase in copayment, impacted individuals are always notified in writing at least 60 days before any change.

See the “Access your formulary” section below to find your pharmacy benefit formulary. 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).

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. There are two ways you, your representative or prescriber can initiate a prior authorization request: Complete the Providence Health Plan Powered by Collective Health online form or your provider may use the drug prior authorization form to submit the exception request.

Use the formulary information above to determine if a drug requires prior authorization or has other restrictions. To request authorization or an exception to restrictions, your provider must complete one of the following forms. You can send a secure email by completing the Providence Health Plan Powered by Collective Health Drug Prior Authorization form below.

• Drug prior authorization form (PDF)
• Uniform prior authorization prescription request form (PDF)
• Online drug prior authorization form

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.

2026 Formulary Prescription drug coverage effective on or after January 1, 2026.
Formulary A (coming soon)
Formulary B (coming soon)
Formulary B - Preventive (coming soon)
Formulary B - Harrison (coming soon)
Formulary C (coming soon)
Formulary D
Formulary F (coming soon)
Formulary J (coming soon)
Formulary K (coming soon)
Formulary L (coming soon)
Formulary P
Formulary P-HSA

 

If you are a current Providence Health Plan Powered by Collective Health member log in to your My Collective account to see your plan specific formulary.

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 Powered by Collective Health has worked with the pharmacy to lower the cost of medication copays for our members.

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 medication(s) filled at a retail pharmacy without the need for an appointment.

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 Powered by Collective Health member, you have access to full-service mail-order medication services through Costco Home Delivery.

Costco Home Delivery offers affordable prescriptions 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.

Have questions? Call a Member Advocate at 855-526-3824, Monday - Friday, 4 a.m. to 6 p.m., and Saturday, from 7 a.m. to 11 a.m. (Pacific Time).

Order prescriptions by mail

• Use this guide to help in creating an account with Costco Home Delivery online at Costco.com/Pharmacy/Home-Delivery
• Costco pharmacy agents are available at 800-607-6861, Monday - Friday, 5 a.m. to 7 p.m., and Saturday, from 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 FAQ and how-to guide

• How to use Costco Home Delivery Pharmacy
• Costco FAQ

Contact information

Costco Home Delivery Pharmacy is available Monday - Friday, 5 a.m. to 7 p.m. (Pacific Time), and Saturday, from 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 Powered by Collective Health as a participating pharmacy for members. You are responsible for the arrangement of services and/or payment of services directly to 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 Powered by Collective Health member, you have access to full-service mail-order medication services through Postal Prescription Services.

Postal Prescription Services offers affordable medications 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.

Your network provisions may require the use of just one of these mail-order pharmacies for coverage.

Have questions? Call a Member Advocate at 855-526-3824, Monday - Friday, 4 a.m. to 6 p.m., and Saturday, from 7 a.m. to 11 a.m. (Pacific Time).

Order prescriptions by mail

• Use this guide to help create an account with Postal Prescription Services online at PPSRX.com
• Kroger Postal Prescription Service agents are available at 503-797-2100 or 800-552-6694, Monday - Friday, 6 a.m. to 6 p.m. (Pacific Time), and Saturday, from 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

Contact information

Postal Prescription Services is available Monday - 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 Powered by Collective Health as a participating pharmacy for members. You are responsible for the arrangement of services and/or payment of services directly to Postal Prescription Services.

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 a Member Advocate at 855-526-3824, Monday - Friday, 4 a.m. to 6 p.m., and Saturday, from 7 a.m. to 11 a.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

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 network 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 Powered by Collective Health to administer vaccines to members.

To find a participating pharmacy:

• If you are a current Providence Health Plan Powered by Collective Health member, log into your My Collective account and search using the Get Care tool. 
• If you are not a current member, visit our online provider directory and "browse by provider network" choose "coverage through my employer" and select the correct network.
  
  
  
  • 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 Powered by Collective Health 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 Powered by Collective Health member ID card with you so the pharmacy can confirm your insurance.

What do Members Pay?

Members may have a $0 copay 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 base 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.

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

Providence Health Plan Powered by Collective Health partners with Rx Savings Solutions to provide a free, confidential service to help you save money on prescriptions. This service is linked to your health plan, so everything is personalized for your medication(s) and plan coverage. 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 medication(s). 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 the medication(s) you take and finds options that may save you money.
• Your online account shows which lower-cost medication(s) may be available under your plan coverage 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.
• The Rx Savings Solutions Pharmacy Support team is available to work with your doctor and pharmacy to help you switch to lower cost medication(s), pharmacies, or mail-order pharmacy.

IMPORTANT NOTE: Rx Savings Solutions is not available to all members. Please call a Member Advocate at 855-526-3824 to determine eligibility. Eligible participants will also receive direct communication from Rx Savings Solutions.

To get started or log in to your Rx Savings Solutions account, visit myrxss.com/ASO/ProvidenceHealthPlan.

To learn more about Rx Savings Solutions, click here.

Need Help? Call 800-268-4476 (TTY 800-877-8973), Monday-Friday, 5 a.m. to 6 p.m. (Pacific Time).

HelpScript may reduce the out-of-pocket costs of select high-cost medications. Eligible members* and their dependents are enrolled in this service automatically.

Features and eligibility:

• Available to eligible members at no cost.
• To find the HelpScript Program’s current eligible medications, click here. 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.

Need help? Contact a HelpScript Patient Advocate at 833-798-6732.

IMPORTANT NOTE: HelpScript is not available to all members. Please call a Member Advocate to determine eligibility.

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

Under the Patient Protection and Affordable Care Act (PPACA), Providence Health Plan Powered by Collective Health offers coverage for certain preventive medications, including some over-the-counter options, with no copayment, coinsurance, or deductible required, though a prescription may be necessary.

• Coverage of Affordable Care Act (ACA) preventive drugs (PDF)
  

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.

Providence Health Plan Powered by Collective Health encourages individuals with problems or concerns about health plan coverage to contact us. In most cases, concerns about billing or coverage can be resolved quickly over the phone. However, if you disagree with our decision about medical bills or health care services, you have a right to varying levels of internal review.

• Grievance and appeal process (PDF)