Formulary and prescription drug information

A formulary is your list of approved drugs. Use this page to access our searchable database and PDFs to learn whether your prescription drug is covered by your Providence Medicare Advantage Plan, as well as information about prior authorization and step therapy.

In addition to formulary information, use this page to access information about:

If you have questions about your plan or formulary choices, please contact customer service.

To find an in-network pharmacy in your area, search our provider and pharmacy directory.

Not a member? Use our zip code tool to view the plans in your area.

2023 Providence Medicare Advantage Plans prescription drug formulary

(except Choice + Rx (HMO-POS), Dual Plus + Rx (HMO D-SNP), Extra + Rx (HMO), and Sycamore + Rx (HMO))

Online formulary search

The formulary above is for members of:

  • Bridge + Rx (HMO-POS)
  • Cottonwood + Rx (HMO-POS)
  • Pine + Rx (HMO)
  • Prime + Rx (HMO)
  • Timber + Rx (HMO)

2023 Providence Medicare Advantage Choice + Rx (HMO-POS) and Extra + Rx (HMO) prescription drug formulary

Online formulary search

The formulary above is for members of:

  • Choice + Rx (HMO-POS)
  • Extra + Rx (HMO)

2023 Providence Medicare Advantage Sycamore + Rx (HMO) prescription drug formulary

Online formulary search

The formulary above is for members of:

  • Sycamore + Rx (HMO)

Medicare Dual Plus plans prescription drug formulary 

Online formulary search

The formulary above is for members of:

  • Providence Medicare Dual Plus (HMO D-SNP)

Medicare Group plans prescription drug formulary 

Align: 2-Tier formulary search

Discover/Explore: 6-Tier formulary search

Rx Savings Solutions 

Providence Medicare Advantage Plans 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, 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 pharmacist help walk you through every step of the process.

Set up your account today: Go to or call 1-800-268-4476 (TTY 1-800-877-8973), Monday-Friday, 5 a.m. to 6 p.m.

Get started today to see how you can save! Here’s how it works:

  • Rx Savings Solutions uses software connected to your Medicare prescription drug benefits. 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. Rx Savings Solutions will consult with your doctor to get their approval on any changes and take care of all of the other details – no effort required from you.

Learn more about Rx Savings Solutions here.

Premium assistance — you may qualify for Extra Help

The government subsidizes prescription drug costs for members with limited incomes.

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for up to 100 percent of drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t know it. For more information about Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.

You can contact customer service at 503-574-8000 or 1-800-603-2340 (TTY: 711), Monday through Sunday, 8 a.m. to 8 p.m. (Pacific Time), if you need additional information, including:

  • How we control the use of services and costs
  • The number of appeals and grievances filed by our members
  • A summary description of how we pay our doctors
  • A description of our financial condition, including a summary of our most recent audit statement

Pharmacy transition process

More information on our pharmacy transition process

Providence Medicare Advantage Plans wants to make your prescription transition as safe and as easy as possible. Review the information below for help guiding you through any prescription drug transition(s). Please read about our transition policy (PDF) for more information

  • What is a formulary?

    Providence Medicare Advantage Plans uses a List of Covered Drugs (formulary or “Drug List”). The Drug List includes Part D prescription drugs that are covered by Providence Medicare Advantage Plans. The drugs on this list are selected by the plan with the help of a team of doctors and pharmacists. The list must meet requirements set by Medicare. Providence Medicare Advantage Plans covers both brand name drugs and generic drugs. Generic drugs have the same active-ingredient as the brand-name drug. Generic drugs usually cost less than brand-name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and equally effective as brand-name drugs. When a generic drug is available for a brand name drug, the brand name drug will generally not be covered and is considered non-formulary. Some drugs may have additional requirements or limits on coverage. These requirements and limits may include:

    • Prior Authorization: For certain drugs, you or your provider need to get approval from Providence Medicare Advantage Plans before we agree to cover the drug for you. This is called “prior authorization.” This means that your provider will need to contact us before you fill your prescription. If you don't get approval, Providence Medicare Advantage Plans may not cover the drug.
    • Quantity Limits: For certain drugs, Providence Medicare Advantage Plans limits the amount of the drug that you can have per prescription or for a defined period of time. For example, if it is normally considered safe to take only one pill per day for a certain drug, we may limit coverage for your prescription to no more than one pill per day.
    • Step Therapy: In some cases, Providence Medicare Advantage Plans requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, we may not cover drug B unless you try Drug A first. If Drug A does not work for you, then we will cover Drug B. This requirement encourages you to try safer or more effective drugs before the plan covers another drug.

    You can access the Providence Medicare Advantage Plans formulary online by selecting the plan's formulary you would like see at the top of this page, or if you have questions regarding our formulary or our transition process you may contact the Providence Medicare Plans Customer Service Team at 503-574-8000 or 1-800-603-2340. If you are hearing impaired and use a Teletype (TTY) Device, please call our TTY line at 711.

    Customer service is available between 8 a.m. and 8 p.m., seven days a week (Pacific time).

  • New member transition restrictions

    The Centers for Medicare and Medicaid Services (CMS) restricts coverage of some drug categories. Providence Medicare Advantage Plans will not cover these drugs during your transition. The following are examples of commonly excluded categories not covered under Medicare Part D:

    • Non-prescription drugs (also called over-the counter)
    • Drugs when used to promote fertility
    • Drugs when used for the relief of cough and cold symptoms
    • Drugs when used for cosmetic purposes or to promote hair growth
    • Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations
    • Drugs when used for the treatment of sexual or erectile dysfunction, such as Viagra, Cialis, Levitra, and Caverject
    • Drugs when used for the treatment of anorexia, weight loss, or weight gain
    • Outpatient drugs for which the manufacturer seeks to require that associated tests or monitoring services be purchased exclusively from the manufacturer as a condition of sale
  • New member transition

    As a new member to our plan, you may be taking a drug that is not on our Drug List (formulary) or has certain restrictions, such as prior authorization, step therapy or quantity limits. While you talk to your doctor to determine the right course of action for you, we will cover a temporary 90-day supply (if you have a prescription written for fewer days, we will allow multiple fills to provide up to a maximum of 90 days of medication) when you go to a network pharmacy. After your first 90-day supply of drugs that are not on our Drug List or drugs that are restricted in some way, we will require medical necessity review even if you have been a member of the plan less than 90 days.

    For example, you may need a prior authorization from us before you can fill your prescription. You should talk to your doctor to decide if you should switch to an appropriate drug that is on our formulary or request a formulary exception so that we will cover the drug you take.

  • New member transition as a long-term care resident

    If you are a resident of a long-term care facility, we will cover a temporary 31-day transition supply (unless you have a prescription written for fewer days). If necessary, we will cover more than one refill of these drugs during the first 90 days you are a member of our plan. If you need a drug that is not on our Drug List or is subject to other restrictions, such as step therapy, but you are past the first 90 days of membership in our plan, we will cover a 31-day emergency supply of that drug (unless the prescription is for fewer days) while you pursue a formulary exception.

  • Current members

    If you are a current member of Providence Medicare Advantage Plans you may be affected by changes in our formulary from one year to the next. You may notice that the drug you are currently taking is no longer on the plan’s drug list (formulary) or the drug you are taking is now restricted in some way. If your drug is not on our drug list or is restricted in some way and you need help switching to a different drug that we cover or requesting a formulary exception, please contact your customer service team at 503-574-8000 or 1-800-603-2340 (TTY: 711). Service is available from 8 a.m. to 8 p.m. (Pacific time), seven days a week.

Information for all Providence Medicare Advantage members with prescription drug benefits: 

The formulary may change at any time. You will receive notice when necessary.

Webpage current as of: 05/12/23

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