Formulary lists of approved drugs

Use 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. 

Providence Medicare Advantage Plans has updated our formularies for 2019. Some medications, such as Humulin®, Proair®, and Ventolin®, may be covered at a different tier. The amount that you pay for your medications may change based upon your plan selection. If you have questions about your plan or formulary choices, please contact customer service.

Select the link that corresponds to your plan:

Providence Medicare Advantage Plans prescription drug formulary 1 ›

  • For members of Extra + RX, Extra Part B Only + RX, Choice + RX, Latitude + RX, Compass + RX, Summit + RX

Providence Medicare Advantage Plans prescription drug formulary 2 ›

  • For members of Prime + RX, Enrich + RX, Harbor + RX, Timber + RX

For Medicare Dual Plus plans ›

  • For members of Providence Medicare Dual Plus (HMO SNP)

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


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