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.