Supplement medical plans with the appropriate pharmacy benefit plan. These plans include a comprehensive prescription drug formulary. Providence proactively takes steps to mitigate the impact of increasing prescription drug costs while ensuring that members continue to have access to safe, effective and affordable medications.
All pharmacy plans include:
- Preventive prescription medications covered in full on ACA preventive prescription medications are covered in full
- Access to more than 35,000 participating pharmacies
- A 90-day supply of maintenance medications for two times the 30-day copay amount when purchased at a preferred retail or mail-order pharmacy
- No separate out-of-pocket maximum
- Prescription cost-shares apply toward the medical plan out-of-pocket maximum
- Covered benefits are included for Tier 1 to Tier 6 preferred generics, non-preferred generics, preferred brand-name drugs, non-preferred brand name drugs and specialty drugs.
- Newly enrolled members have access to a 90-day transition period for most prescriptions that normally require prior authorization
- Care management for members with chronic conditions, including support for medication adherence, help identifying harmful drug interactions and help identifying opportunities to reduce health care costs
For more information on these products, formularies or participating pharmacies, see pharmacy resources.
To get a list of preventive medications Providence Health Plan covers without imposing a copayment, coinsurance or deductible, download the Affordable Care Act (ACA) list of preventive prescription medications (PDF).
Mail-order benefits are available on all pharmacy plans. A 90-day supply of maintenance medication is available for two times the 30-day copay amount when purchased at a preferred retail or preferred mail-order pharmacy.