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).

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.

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.

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

• Health Share of Oregon/Providence (Medicaid) 
• 2025 Medicare Part D

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

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. 

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

• How to use Costco Home Delivery Pharmacy
• Costco FAQ

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.

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

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

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.

• Freedom Fertility Pharmacy
• New Era Pharmacy
• OHSU Fertility Pharmacy Services
• SMP Pharmacy

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 RxAssist^TM

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.

• Formulary updates (PDF)
  A summary of upcoming changes to your formulary

• Coverage of Affordable Care Act (ACA) preventive drugs (PDF)
  Information about which preventive drugs are covered without imposing a copayment, coinsurance or deductible.

• Emergency Prescription Fills (PDF)
  Information for emergency prescriptions fills for Washington Commercial members only.

• 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.

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 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.

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.

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.

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 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.

If you’re a Medicaid (OHP) member, visit https://www.healthshareoregon.org/members/vaccines for more information.