2022 PROVIDENCE FORMULARY A

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, hospitalization, and/or death in some patients.

Vaccination is a safe, effective, and reliable way to prevent getting sick from COVID-19. The Food & Drug Administration (FDA) has authorized the use of four different COVID-19 vaccines under an Emergency Use Authorization (EUA) to help stop the spread of the disease in adult patients. These are vaccines made by Pfizer-BioNTech (adult and child dosing), Moderna, and Johnson & Johnson. Vaccination with Pfizer-BioNTech is now approved under the EUA for all patients aged 5 years and up.

In addition, the FDA has recently 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 (EUA and FDA approved) 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.

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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
• 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 / Generic Alternatives

Formulary Exception: There may be times when you require a drug that is not on the formulary. If you currently take a prescription drug not on the formulary, contact customer service to make sure the drug is not covered. If the prescription drug is not covered, your provider may request an exception be made. There are two ways you, your representative or prescriber can initiate a prior authorization request: Complete the Providence Health Plan drug coverage prior authorization form or your provider may use the drug prior authorization form to submit the exception request.

Generic Alternatives: A generic alternative is a generic drug that is used to treat the same condition as a brand-name drug; it is not the exact same medication as the brand-name drug. According to clinical evidence, a generic alternative can be expected to treat the same condition as well as the brand-name alternative. A new prescription is needed to obtain a generic alternative drug. You may search the formulary by medical condition category and look for a medication classified as generic.

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.