2021 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. 

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

Providence Medicare Advantage Plans prescription drug formulary (except Extra + Rx 001 (HMO) and Extra + Rx 002 (HMO))

Online formulary search

  • The formulary above is for members of Bridge 1 + Rx (HMO-POS), Bridge 2 + Rx (HMO-POS), Choice + Rx 001 (HMO-POS), Choice + Rx 002 (HMO-POS), Compass + Rx (HMO-POS), Cottonwood + Rx (HMO-POS), Enrich + Rx (HMO), Harbor + Rx (HMO), Latitude + Rx (HMO-POS), Pine + Rx (HMO), Prime + Rx (HMO), Summit + Rx (HMO-POS), Timber + Rx (HMO)

Providence Medicare Advantage Extra + Rx 001 (HMO) and Extra + Rx 002 (HMO) prescription drug formulary

Online formulary search

  • The formulary above is for members of Extra + Rx 001, Extra + Rx 002 and Extra Part B Only + Rx

For Medicare Dual Plus plans

Online formulary search

  • The formulary above is for members of Providence Medicare Dual Plus (HMO D-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.


Website is current as of: 10/08/2020