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Providence Medicare Advantage Plans (Medicare Part D) Pharmacy Resources
Search for nationwide pharmacy providers available through Providence Health Plans.
2010 Formulary (Drug List)
- 2010 Medicare Drug Formulary (PDF)
- 2010 Prior Authorization Criteria
- 2010 Step Therapy Criteria
- 2010 Quantity Limit Criteria
- Effective Generic Medications (PDF)
- Best Available Evidence - Centers for Medicare & Medicaid Services Web site
2009 Formulary (Drug List)
Please review the Formulary for the copay or coinsurance amount for each drug.
- 2009 Medicare Drug Formulary (PDF)
- Formulario 2009 (PDF)
- 2009 Prior Authorization Criteria
- Directorio de farmacias (PDF)
- Best Available Evidence - Centers for Medicare & Medicaid Services Web site
Pharmacy FAQs
- Can the formulary change?
- How to I find an in-network pharmacy in my area?
- Filling prescriptions outside of the network
- Member Pharmacy Transition Process
- Medication Therapy Management (MTM) Program
For more information contact the Providence Medicare Advantage Plans Sales Team.
Out-of-Network Pharmacies
In certain situations, prescriptions filled at an out-of-network pharmacy may also be covered. Generally, we only cover drugs filled at an out-of-network pharmacy in limited, non-routine circumstances when a network pharmacy is not available.
Coverage Determination/Appeals and Grievances
- Part D Coverage Determinations, Exceptions, Appeals and Grievances
- Appointment of Representative Form (PDF)
Nombramiento de representante (PDF)
If you would prefer that someone else act on your behalf, please fill out this form, sign it and return it to us.- In writing, to Providence Medicare Advantage Plans, Attn: Appeals and Grievance Department P.O. Box 4327 Portland, OR 97208-4327.
- By fax, at 1-800-396-4778.
- By telephone – if it is a fast appeal – at 503-574-8000 or 1-800-603-2340.
- In person, at Providence Health Plan, Appeals and Grievance Department, 3601 SW Murray Blvd., Suite 10 Beaverton, OR 97005.
You can contact customer service if you need additional information, including:
- How we control the use of services and costs;
- The number of appeals and grievances filed by our members;
- A summary description of how we pay our doctors; or
- A description of our financial condition, including a summary of our most recent audit statement.
*We have 677 pharmacies available in our service area in addition to 20,000 pharmacies nationwide. Providence Health Plan has contracts with pharmacies that equals or exceeds CMS requirements for pharmacy access in your area.
You may be eligible to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting help, call:
- 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week;
- The Social Security office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778; or
- Your state Medicaid office.
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