2024 Online formulary search

2025 Online formulary search

2024 Online formulary search

2025 Online formulary search

2024 Online formulary search

2025 Online formulary search

2024 Online formulary search

2025 Online formulary search

2024 Align: 2-tier formulary search

2024 Discover/Explore: 5-tier formulary search

2025 Align: 2-tier formulary search

2025 Discover/Explore: 5-tier formulary search

Providence Medicare Advantage Plans uses a List of Covered Drugs (formulary or “Drug List”). The Drug List includes Part D prescription drugs that are covered by Providence Medicare Advantage Plans. The drugs on this list are selected by the plan with the help of a team of doctors and pharmacists. The list must meet requirements set by Medicare. Providence Medicare Advantage Plans covers both brand name drugs and generic drugs. Generic drugs have the same active-ingredient as the brand-name drug. Generic drugs usually cost less than brand-name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and equally effective as brand-name drugs. When a generic drug is available for a brand name drug, the brand name drug will generally not be covered and is considered non-formulary. Some drugs may have additional requirements or limits on coverage. These requirements and limits may include:

Prior Authorization: For certain drugs, you or your provider need to get approval from Providence Medicare Advantage Plans before we agree to cover the drug for you. This is called “prior authorization.” This means that your provider will need to contact us before you fill your prescription. If you don't get approval, Providence Medicare Advantage Plans may not cover the drug.

Quantity Limits: For certain drugs, Providence Medicare Advantage Plans limits the amount of the drug that you can have per prescription or for a defined period of time. For example, if it is normally considered safe to take only one pill per day for a certain drug, we may limit coverage for your prescription to no more than one pill per day.

Step Therapy: In some cases, Providence Medicare Advantage Plans requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, we may not cover drug B unless you try Drug A first. If Drug A does not work for you, then we will cover Drug B. This requirement encourages you to try safer or more effective drugs before the plan covers another drug.

You can access the Providence Medicare Advantage Plans formulary online by selecting the plan's formulary you would like see at the top of this page, or if you have questions regarding our formulary or our transition process you may contact the Providence Medicare Plans Customer Service Team at 503-574-8000 or 1-800-603-2340. If you are hearing impaired and use a Teletype (TTY) Device, please call our TTY line at 711.

Customer service is available between 8 a.m. and 8 p.m., seven days a week (Pacific Time).

As a Providence Health Assurance 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. You don’t need to be a Costco member to fill your prescriptions with Costco Home Delivery or at a Costco warehouse. Please call the Providence Health Assurance Pharmacy Department at Update to: 503-574-8000 or 1-800-603-2340 if you have questions.

Order prescriptions by mail

• Use this guide to help in creating an account with Costco Home Delivery online at http://www.costco.com/Pharmacy/home-delivery.
• Costco pharmacy agents are available at 1-800-607-6861, 5 a.m. to 7 p.m. (Pacific Time), Monday - Friday, 9:30 a.m. to 2 p.m. (Pacific Time), Saturday
• Your doctor may also fax in new or refill orders at 1-800-633-0334
• 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

Mon – Fri 5 a.m. to 7 p.m. PT, Sat 9:30 a.m. to 2 p.m. PT
Pharmacy is available 24/7 to refill prescriptions, order new prescriptions and check prescription status.
Phone: 1-800-607-6861
Fax: 1-800-633-0334
Mailing address:
802 134th St. SW Ste 140, Everett, WA 98204-7314
email: webpharmacy@costco.com
Costco Home Delivery contracts with Providence Health Assurance 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 Assurance 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 Assurance as a participating pharmacy for members. You are responsible for arrangement of services and/or payment of services directly to Postal Prescription Services.

A preferred retail pharmacy can provide up to a 100-day supply of prescription drugs. Search the pharmacy directory for a pharmacy near you.

A standard retail pharmacy can provide up to a 100-day supply of prescription drugs plus any difference in the cost if you were to have used a preferred retail pharmacy for a 84-100 days supply. Search the pharmacy directory for a pharmacy near you.

Specialty drugs are prescriptions that require special delivery, handling, administration and monitoring by a pharmacist. These drugs are listed on the Providence Health Assurance formulary with a status of "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 503-574-8000 or 1-800-603-2340 (TTY: 711), 7 days a week, 8 a.m. to 8 p.m. (Pacific Time). Calls to this number are free. Customer Service also has free language interpreter services available for non-English speakers.

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.

 

 

What Vaccines are Covered?

 

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.

 

 

Finding Participating Pharmacies

 

Many nationwide chains, regional chains and independent pharmacies contract with Providence Health Assurance 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 Assurance member ID card for help in finding a participating pharmacy that can provide vaccinations near you.

 

 

Before You Go to the Pharmacy

 

Call the pharmacy of your choice for complete details and confirm:

 

• The pharmacy’s participation in Providence Health Assurance’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 Assurance member ID card with you so they can confirm your insurance.

 

 

What do Members Pay?

 

Members may have a $0 co-pay at in-network pharmacies for covered vaccines.

 

To get specifics on what your plan covers, check your plan materials or call us at 503-574-8000 (toll-free: 1-800-603-2340), 8 a.m. to 8 p.m. (Pacific Time), seven days a week.

Simplify Your Medication Routine with Customized Dose Packaging

Personalized dose packaging is designed to make managing your medications easier and more convenient. Each package contains presorted, sealed pouches organized by the time of day—morning, afternoon, evening, or bedtime—ensuring you take the right medication at the right time, every time. This eliminates the hassle of daily or weekly pill containers.

For added convenience, this packaging service is available through our preferred home delivery pharmacies. If you’re taking multiple medications daily, our home delivery options provide this service at no extra cost. Your eligible medications will arrive at your doorstep, with prescription refill dates synchronized to minimize multiple deliveries or trips to the pharmacy.

To start receiving your medications in customized dose packaging, choose from our Preferred Home Delivery Options:

• Exactcare – Click the Get Started button on their website or call: 877-355-7225
• SelectRx – Click the Get Started button on their website or call: 833-307-1517

Extra Help, also known as a Part D Low-Income Subsidy, or LIS, is a federal program that helps lower prescription costs and Part D (prescription) costs for Medicare Advantage members. Learn more about Extra Help by connecting with one of our team members who can help walk you through how the program works.

Call: 503-574-8416 (TTY: 711)

Learn more about Extra Help

2024 Subsidized Premium Table (PDF)
2025 Subsidized Premium Table (PDF)

Providence Medicare Advantage Plans 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, 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 pharmacist help walk you through every step of the process.

Set up your account today: Go to myrxss.com/ProvidenceMA or call 1-800-268-4476 (TTY 1-800-877-8973), Monday-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 Medicare prescription drug benefits. 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

We want to make it easy for you to get the medications you need, and we want to help you save time and money. You can get a 100-day supply of your medications, usually at a reduced cost at mail-order pharmacies.

As a new member to our plan, you may be taking a drug that is not on our Drug List (formulary) or has certain restrictions, such as prior authorization, step therapy or quantity limits. While you talk to your doctor to determine the right course of action for you, we will cover a temporary 30-day supply (if you have a prescription written for fewer days, we will allow multiple fills to provide up to a maximum of 30 days of medication) when you go to a network pharmacy. After your first 30-day supply of drugs that are not on our Drug List or drugs that are restricted in some way, we will require medical necessity review even if you have been a member of the plan less than 30 days.

For example, you may need a prior authorization from us before you can fill your prescription. You should talk to your doctor to decide if you should switch to an appropriate drug that is on our formulary or request a formulary exception so that we will cover the drug you take.

The Centers for Medicare and Medicaid Services (CMS) restricts coverage of some drug categories. Providence Medicare Advantage Plans will not cover these drugs during your transition. The following are examples of commonly excluded categories not covered under Medicare Part D:

• Non-prescription drugs (also called over-the counter)
• Drugs when used to promote fertility
• Drugs when used for the relief of cough and cold symptoms
• Drugs when used for cosmetic purposes or to promote hair growth
• Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations
• Drugs when used for the treatment of sexual or erectile dysfunction, such as Viagra, Cialis, Levitra, and Caverject
• Drugs when used for the treatment of anorexia, weight loss, or weight gain
• Outpatient drugs for which the manufacturer seeks to require that associated tests or monitoring services be purchased exclusively from the manufacturer as a condition of sale

If you are a resident of a long-term care facility, we will cover a temporary 31-day transition supply (unless you have a prescription written for fewer days). If necessary, we will cover more than one refill of these drugs during the first 90 days you are a member of our plan. If you need a drug that is not on our Drug List or is subject to other restrictions, such as step therapy, but you are past the first 90 days of membership in our plan, we will cover a 31-day emergency supply of that drug (unless the prescription is for fewer days) while you pursue a formulary exception.

If you are a current member of Providence Medicare Advantage Plans you may be affected by changes in our formulary from one year to the next. You may notice that the drug you are currently taking is no longer on the plan’s drug list (formulary) or the drug you are taking is now restricted in some way. If your drug is not on our drug list or is restricted in some way and you need help switching to a different drug that we cover or requesting a formulary exception, please contact your customer service team at 503-574-8000 or 1-800-603-2340 (TTY: 711). Service is available from 8 a.m. to 8 p.m. (Pacific time), seven days a week.

Starting in 2025, anyone with a Medicare drug plan or Medicare health plan with drug coverage (like a Medicare Advantage Plan with drug coverage) can use this payment option for drugs covered by Part D.

If you select this payment option, each month you’ll continue to pay your plan premium (if you have one), and you’ll get a bill from Providence Medicare Advantage Plans to pay for your prescription drugs (instead of paying the pharmacy). All of our Part D plans offer this payment option, and participation is voluntary. It doesn’t cost anything to participate in the Medicare Prescription Payment Plan, and you won’t pay any interest or fees on the amount you owe, even if your payment is late. 

If you have high out-of-pocket drug costs, this payment option spreads out what you’ll pay each month across the calendar year (Jan – Dec), so you don’t have to pay out-of-pocket costs to the pharmacy. This payment option might help you manage your expenses, but it doesn’t save you money or lower your drug costs.

This payment option might not be the best choice for you if:

• Your yearly drug costs are low
• Your drug costs are the same each month
• You’re considering signing up for the payment option late in the calendar year (after September)
• You don’t want to change how you pay for your drugs
• You get or are eligible for Extra Help from Medicare
• You get or are eligible for a Medicare Savings Program
• You get help paying for your drugs from other organizations, like a State Pharmaceutical Assistance Program (SPAP) or a charity

The program is free to join, there are no fees or interest charged under the program, the program does not reduce the amount of cost-sharing a participant owes for their prescriptions.

The new prescription drug law caps your out-of-pocket costs at $2,000 in 2025 and eliminates the coverage gap (known as the “donut hole”). This means you’ll never pay more than $2,000 in out-of-pocket drug costs in 2025. This is true for everyone with Medicare Part D drug coverage, even if you don’t join the Medicare Prescription Payment Plan.

If you miss paying a monthly payment, Providence Medicare Advantage Plans will reach out to let you know. We will provide your missed due date, the amount you owe, and the date for the end of the grace period. The grace period is 2 months.

If you do not pay before the end of the grace period, you will be removed from the program and will be required to pay your full copay amount when you pick up your prescription at the pharmacy. You will still be required to pay the amount you owe, but will not pay any interest or fees.

Fill out the Election Form and mail, email or fax it in:

Election Form 

English | Spanish | Vietnamese

On the CapitalRx Online Portal

Call the Customer Care Phone Service at 1-855-742-2779 (TTY: 711) 24 hours a day, 7 days a week

We will send a notice when you are active in the Medicare Prescription Payment Plan. Until then you will need to continue to pay at the pharmacy.

You take several high-cost drugs that have a total out-of-pocket cost of $500 each month. In January 2025, you join the Medicare Prescription Payment Plan through your Medicare drug plan or Medicare health plan with drug coverage.

We calculate your first month’s bill in the Medicare Prescription Payment Plan differently than your bill for the rest of the months in the year:

First, we figure out your “maximum possible payment” for the first month: 
$2,000 [annual out-of-pocket maximum] – $0 [no out-of-pocket costs before using this payment option] = $2,000. Then divide that by 12 [remaining months in the year] = $166.67 “maximum possible payment”

Then, we figure out what you’ll pay for January:

• Compare your total out-of-pocket costs for January ($500) to the “maximum possible payment” we just calculated: $166.67.
• Your plan will bill you the lesser of the two amounts. So, you’ll pay $166.67 for the month of January.
• You have a remaining balance of $333.33 ($500-$166.67).

For February and the rest of the months left in the year, we calculate your payment differently: 
$333.33 [remaining balance] + $500 [new costs] = $833.33. Then divide by 11 [remaining months in the year] = $75.76 for your payment in February.

We’ll calculate your March payment like we did for February: 
$757.57 [remaining balance] + $500 [new costs] = $1,257.57. Then divide by 10 [remaining months in the year] = $125.76 for your payment in March.

In April, when you refill your prescriptions again, you’ll reach the annual out-of-pocket maximum for the year ($2,000 in 2025). You’ll continue to pay what you already owe and get your prescription(s), but after April you won’t add any new out-of-pocket costs for the rest of the year.

$1,131.81 [remaining balance] + $500 [new costs] = $1631.81. Then divide by 9 [remaining months in the year] = $181.31 for your payment for April.

Even though your payment varies each month, by the end of the year, you’ll never pay more than: 

• The total amount you would have paid out-of-pocket.
• The total annual out-of-pocket maximum ($2,000 in 2025).

Remember, this is just your monthly payment for your out-of-pocket drug costs. You still need to pay your health or drug plan’s premium (if you have one) each month.

If you believe that any delay in filling the prescription(s) may seriously jeopardize your life, health, or ability to regain maximum function, Providence Medicare Advantage Plans must process an urgent retroactive election request when you inquire within 72 hours of the date and time the urgent claim(s) were decided.

File a complaint or grievance here.

Need Extra Help paying for your prescriptions? Extra Help is a federal program that is available for Medicare eligible individuals in the U.S. who are age 63 and over and meet income requirements. Extra Help lowers prescription drug costs and the Part D premium to $0, in most cases resulting in a $0 monthly premium. As of 2024 more individuals qualify for Extra Help due to the expansion of eligibility.

Learn more