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 Resources flyer



Formulary


List of drugs covered under your plan

You have access to a comprehensive prescription drug formulary designed to promote safe, effective, and affordable drug therapy. Your formulary is easy to search, includes information about the drug, and includes special considerations about the prescription, if they apply.

  • Finding and searching your formulary

    See the “Access your formulary by health plan type” section below to find your pharmacy benefit formulary. First, select the type of health plan you have, then click the linked formulary that applies to your medical plan. 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).

  • Formulary Exception

    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 drug coverage prior authorization form or your provider may use the drug prior authorization form to submit the exception request.

  • 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.

  • Formularies available to members enrolled in coverage through their employer

    2024 Formulary


    Prescription drug coverage effective on or after January 1, 2024.

    2025 Formulary


    Prescription drug coverage effective on or after January 1, 2025.

    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
    Formulary F Formulary F (Coming Soon) 
    Formulary J Formulary J (Coming Soon)
    Formulary K Formulary K (Coming Soon)
    Formulary L  
    Formulary P  Formulary P
     Formulary P-HSA Formulary P-HSA

     

  • View your plan formulary

    The drug formulary specific to your health plan coverage is available within your myProvidence account. Once logged in: 

     

    • Navigate to “My Health Tools”
    • Select “Pharmacy Information” from the drop down
     

Access your formulary by health plan type


You can also find your plan formulary below. Select your health plan coverage type below, then click the linked formulary that applies to your medical plan.

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).

Requesting authorization for your drugs

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 Drug Prior Authorization form below.


Prior Authorization Flyer

 

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
  • Retail pharmacy

    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.

     
  • Preferred retail 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. 

  • 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, your network provisions may require the use of just one mail order pharmacy for coverage.


    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 Costco.com/Pharmacy/Home-Delivery
    • 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.


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


    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
    • Kroger 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


    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

    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

    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.


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.


    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 depends on the plan you have. If you have an ID card that looks like this (please note the specific logo), use the Rx Savings Solutions portal weblink below.




    Set up your account today: Go to myrxss.com/ProvidenceHealthPlan or call 800-268-4476 (TTY 800-877-8973), Monday through Friday, 5 a.m. to 6 p.m. (Pacific Time).


    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.

    Learn more about Rx Savings Solutions here.

  • Smart Rx Assist™

    Smart RxAssistTM

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

    Smart RxAssist may reduce your copay to $0 on select specialty medications. Eligible members* are enrolled automatically. A specialized patient navigator will assist you every step of the way.


    Program Features and Eligibility 


    The Smart RxAssist program may help lower your out-of-pocket costs to $0 for eligible specialty medications. In some cases, you may have a small fee which you will be reimbursed for via check within 45 days.


    • There is no cost to members for participating in the Smart RxAssist program.
    • The medications currently eligible for the Smart RxAssist program are listed below. Medications eligible for the program are subject to change.
    • Because this program provides a $0 cost not subject to deductible, the tax laws regarding a health savings account makes the program unavailable to those enrolled in a Health Savings Account (HSA) medical plan.

    Smart RxAssist Program List


    *HSA, Medicare, Medicaid, Members 65 years and older, and Washington plan-based members are ineligible for the Smart RxAssist Program.

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

Rx Savings Solutions User

Medical benefit drug authorization

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.

  • Medical Service Prior Authorization List (PDF)
    This list includes medications that are injected, infused or otherwise administered by a health care professional that are covered under your medical benefit.




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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