Request a formulary

Please complete the form below to have a 2019 paper formulary mailed to you.

Request a 2018 paper formulary ›

Consider the following when making the formulary selection:

  • Providence Medicare Advantage Plan Prescription Drug Formulary 1:
    Formulary for all 2019 Extra + RX, Extra Part B Only + RX, Choice + RX, Latitude + RX, Compass + RX, Summit + RX members, and all group members
  • Providence Medicare Advantage Plan Prescription Drug Formulary 2:
    Formulary for all 2019 Prime + RX, Enrich + RX, Harbor + RX, Timber + RX members
  • Providence Medicare Advantage Plans Dual Plus:
    Formulary for members of our Dual Plus (HMO SNP) plan

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

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