2021 Health Share of Oregon/ Providence (OHP)

Welcome Health Share/Providence has a list of covered drugs called a Formulary.

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 first use of COVID-19 vaccines under an Emergency Use Authorization (EUA) to help stop the spread of the disease. Since then the FDA has granted full approval to the Pfizer-BioNTech COVID-19 Vaccine for people 16 years and older, which is now marketed as “Comirnaty”.

All COVID-19 vaccines will be covered in full (no out-of-pocket costs).

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

La COVID-19 es la enfermedad infecciosa causada por el coronavirus que se ha descubierto más recientemente. Es una enfermedad muy contagiosa. Los infectados con el COVID-19 pueden ser contagiosos aunque las personas no tengan síntomas o se sientan enfermos. Este virus puede traer consigo una enfermedad grave o incluso la muerte.

Cuando la vacuna esté autorizada y aprobada en los Estados Unidos en Diciembre del 2020, al principio es posible que no haya suficientes dosis disponibles para todos los adultos. Es decir que no todos podrán vacunarse de inmediato. Los suministros irán aumentando con el paso del tiempo. Los trabajadores de salud y los residentes de establecimientos de cuidados a largo plazo deberían recibir las primeras dosis de las vacunas contra el COVID-19. Estudios medicos muestran que las vacunas son seguras y efectivas para prevenir la infección por el COVID-19.

Se proporcionará cobertura de administración de las vacunas contra el COVID-19 sin gasto compartido, para los miembros del Medicaid.

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.

If you are 19 or older, you can get the flu shot at an in-network retail pharmacy. Children (ages infant through 18) need to go to a Vaccine for Children facility (VFC), or to your PCP.

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

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.

Search by selecting the therapeutic class of the medication you are looking for.

WHAT IF MY DRUG IS NOT ON THE FORMULARY?

If your drug is not on the formulary, it means we do not cover it.

Your doctor can ask for an exception. Ask your doctor to mail or fax us a “prior authorization” or Medication Exception Request Form if they feel this is the best drug for you.

We will review your doctor’s request and either approve or deny the request.

WHAT IF I URGENTLY NEED A DRUG THAT IS NOT ON THE FORMULARY?

If this happens, please contact us right away. You, your doctor, or someone you appoint as your representative can contact us.

If we determine that your life or health are at risk, we will review the request within one day (24 hours).

You can also call our Customer Service team at one of the following numbers between 8 a.m. and 5 p.m., Monday through Friday if you have questions about the formulary:

Customer Service: 503-574-8200

Toll-Free: 1-800-898-8174

TTY/TDD users should call 711

Please see your Member Handbook or contact the Pharmacy Department at (877)216-3644 for questions.