2020 PROVIDENCE FORMULARY J

Welcome

Providence Health Plan is pleased to provide plan members with a comprehensive prescription drug formulary designed to promote safe, effective and affordable drug therapy. We cover both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a 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 effective as brand name drugs.

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COVID-19

Coronavirus disease 2019 – also known as COVID19 – is a highly contagious respiratory virus that has caused a global pandemic due to its ability to spread quickly, even by people that do not have any symptoms of the disease. While many patients experience mild symptoms, the virus can cause very severe disease and death in some patients.

In December 2020, the Food & Drug Administration (FDA) approved the use of COVID-19 vaccines under an Emergency Use Authorization (EUA) to help stop the spread of the disease. This vaccine will be covered in full (no out-of-pocket costs). Please note that vaccine administration will not be available for everyone right away; the government will be limiting initial vaccinations to those at highest risk (such as front-line healthcare workers, long-term care residents, and elderly patients).

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Influenza

Influenza — also known as the flu — is a highly contagious respiratory virus. The effects of the flu vary from person to person and range from mild to severe. The best protection against the flu is to get a flu shot each year.

Did you know that you may be able to get a flu shot at an in-network pharmacy?

Flu vaccines are available at many retail pharmacy locations or through your in-network health care provider.

Going to the pharmacy is a convenient option as generally no appointment is needed and flu shots are covered at no cost to our members with proof of insurance.

To find an in-network pharmacy: You can call Customer Service at 503-574-7500 (TTY: 711), Pharmacy Services at 503-574-7400 (TTY: 711), or access the Pharmacy Directory.

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Search the formulary

There are a number of ways to see if your prescription is included in the formulary. You can search:

Use the alphabetical list to search by the first letter of your medication.

Search by typing part of the generic (chemical) and brand (trade) names.

Printable Files

The following files require Adobe Acrobat. Download Adobe Acrobat

• Printable Formulary
• Prior Authorization
• Step Therapy

Prescription drug coverage

Generally, your prescription drug plan covers prescription drugs that:

Are medically necessary;

Are filled at an in-network pharmacy; and that

Meet the criteria described in your member materials, such as prior authorization and step-therapy, when needed. Your member materials, including your prescription drug benefit summary, are available through myProvidence when you create a free account.

Formulary exceptions

There may be times when you require a medication that is not on the formulary. If you currently take a prescription drug that is not on the formulary, contact customer service to confirm the drug is not covered. If the prescription drug is not covered, your provider may request an exception be made.

More information

Visit the Providence Health Plan Pharmacy Resources page for more information about prescription drugs, including forms, articles, and answers to frequently asked questions.