2021 PROVIDENCE FORMULARY F

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 Vaccination

Vaccination is a safe, effective, and reliable way to prevent getting sick from COVID-19. Getting vaccinated is one of the best ways to protect you and your family.

COVID-19 vaccines are available at no cost
All FDA-authorized and FDA-approved COVID-19 vaccines are provided at no charge to you, no matter where you get the vaccine. This includes when multiple doses are required. Everyone 5 years of age and older is eligible to get a COVID-19 vaccine

All people 5 and older living in the US are now eligible for the Pfizer-BioNTech COVID-19 vaccine.

The FDA granted full approval to the Pfizer-BioNTech COVID-19 Vaccine for people 16 years and older, which is now marketed as “Comirnaty”.

All people 18 and older living in the US are now eligible for the Moderna COVID-19 vaccine and the Johnson & Johnson’s Janssen COVID-19 vaccine.

The most current vaccine information, including recommendations for boosters and special populations, can be found on the CDC website.

For the most update to information on COVID-19 Vaccine, please visit our Frequently Asked Questions (FAQ) page.

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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

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
• Formulary Changes

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.