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PROVIDENCE MEDICARE ADVANTAGE PLANS (2025)

ALIGN GROUP PLAN + RX (HMO) 15/30 AND ALIGN GROUP PLAN + RX (HMO) 10/50/1000

 

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.

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) or brand (trade) names.
  • Search by selecting the therapeutic class of the medication you are looking for.

Drug Search Main Content

Alphabetical Search Skip to Brand & Generic Search
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Therapeutic Class Search Skip to Footer

  • Analgesics
  • Anesthetics
  • Anti-Addiction/ Substance Abuse Treatment Agents
  • Antibacterials
  • Anticonvulsants
  • Antidementia Agents
  • Antidepressants
  • Antiemetics
  • Antifungals
  • Antigout Agents
  • Antimigraine Agents
  • Antimyasthenic Agents
  • Antimycobacterials
  • Antineoplastics
  • Antiparasitics
  • Antiparkinson Agents
  • Antipsychotics
  • Antispasticity Agents
  • Antivirals
  • Anxiolytics
  • Bipolar Agents
  • Blood Glucose Regulators
  • Blood Products And Modifiers
  • Cardiovascular Agents
  • Central Nervous System Agents
  • Dental And Oral Agents
  • Dermatological Agents
  • Electrolytes/Minerals/Metals/Vitamins
  • Gastrointestinal Agents
  • Genetic Or Enzyme Or Protein Disorder: Replacement, Modifiers, Treatment
  • Genitourinary Agents
  • Hormonal Agents, Stimulant/ Replacement/ Modifying (Adrenal)
  • Hormonal Agents, Stimulant/ Replacement/ Modifying (Pituitary)
  • Hormonal Agents, Stimulant/ Replacement/ Modifying (Prostaglandins)
  • Hormonal Agents, Stimulant/ Replacement/ Modifying (Sex Hormones/ Modifiers)
  • Hormonal Agents, Stimulant/ Replacement/ Modifying (Thyroid)
  • Hormonal Agents, Suppressant (Adrenal Or Pituitary)
  • Hormonal Agents, Suppressant (Thyroid)
  • Immunological Agents
  • Inflammatory Bowel Disease Agents
  • Metabolic Bone Disease Agents
  • Non-Frf Drugs
  • Ophthalmic Agents
  • Otic Agents
  • Respiratory Tract/ Pulmonary Agents
  • Skeletal Muscle Relaxants
  • Sleep Disorder Agents
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Immunizations and vaccines

Immunizations and vaccines are important because they help protect us from serious diseases throughout our lives. This not only keeps you healthy, but it also helps stop the spread of diseases to other people, making the whole community safer. 

Many vaccines are available to you at NO COST with proof of insurance! Plus you can get these at many pharmacies near you (or at your healthcare provider’s office). These vaccines include (but are not limited to): 
• Influenza (the flu shot)
• COVID
• Shingles (Herpes Zoster)
• RSV (Respiratory Syncytial Virus)
• Pneumonia (Pneumococcal)

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 you Evidence of Coverage.

Printable Files

The following files require Adobe Acrobat. Download Adobe Acrobat.

  • Printable Formulary
  • Prior Authorization
  • Step Therapy
  • Notice of Availability of Language Assistance Services

How to Request an Exception

You can ask up to make an exception to our coverage rules. There are several types of exceptions that you can ask us to make:

  • You can ask us to cover your drug even if it is not on our formulary
  • You can ask us to waive coverage restrictions or limits on your drug
  • You can ask us to provide a higher level of coverage for your drug

Additional information

  • Can the formulary change?
  • Best Available Evidence - Centers for Medicare & Medicaid Services

The formulary and pharmacy network may change at any time. You will receive notice when necessary.

You should contact us for an initial coverage decision for a formulary or utilization restriction exception. When you are requesting a formulary or utilization 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, 771, seven days a week, between 8 a.m. and 8 p.m. (Pacific time).

This page is managed by Providence Health Assurance using an MMIT platform.
Formulary Id: 25306
Formulary Effective Date: 05/01/2025
Updated:
05/2025
CMS Approval Date:
04/22/2025
CMS Version:
25

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