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PROVIDENCE MEDICARE ADVANTAGE PLANS 2021 FORMULARY
Your Providence Medicare Advantage Plan covers 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.
COVID-19Coronavirus 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).
COVID-19 Vaccine Frequently Asked Questions (FAQ).
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?
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.
What is a Formulary?
A formulary is a list of covered drugs which represents the prescription therapies believed to be a necessary part of a quality treatment program. We will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.
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How to Search For Drugs
How to Request an Exception
You can ask us to make an exception to our coverage rules. There are several types of exceptions that you can ask us to make:
The formulary and pharmacy network may change at any time. You will receive notice when necessary.
You should contact us to ask us for an initial coverage decision for a formulary or utilization restriction exception. When you are requesting a formulary or utilization restriction exception you should submit a statement from your physician supporting your request. Generally, we must make our decision within 72 hours of getting your prescribing physician’s supporting statement. You can request an expedited (fast) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 72 hours for a decision. If your request to expedite is granted, we must give you a decision no later than 24 hours after we get your prescribing physician’s supporting statement.
Providence Medicare Advantage Plans is an HMO, HMO-POS, and HMO SNP with Medicare and Oregon Health Plan contracts. Enrollment in Providence Medicare Advantage Plans depends on contract renewal.
For questions, please contact Providence Health Assurance Customer Service at 503-574-8000 or 1-800-603-2340 or, for TTY users, 711, seven days a week, between 8 a.m. and 8 p.m. (Pacific time).
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