Providence ElderPlace Prescription Medications
Also known as:
Providence ElderPlace, in consultation with Providence Health Plans Ambulatory Pharmacy and Therapeutic Committee, has selected a list of medications that represent the prescription therapies believed to be a necessary part of a quality treatment program. This list, called a formulary, is updated every three months.
Over-the-counter medications are included in the formulary and are provided to all ElderPlace participants.
Can the formulary change?
Yes. Providence ElderPlace may add or remove medications from the formulary. If drugs are removed from the formulary, or pre-authorization are requirements added, ElderPlace will notify participants who use that medication at least 60 days before the change becomes effective. If the Food & Drug Administration determines that an item on the formulary list is unsafe, ElderPlace will immediately remove the item from the formulary and notify participants who use it.
What if my medication is not on the formulary?
You and your primary care physician can ask Providence ElderPlace to make an exception and cover the medication even if it is not on our formulary. Providence ElderPlace will provide time for you to transition to our formulary. The Transition Process for Medicare Part D Policy (see attachment below) describes the transition period and how you can obtain a temporary supply of your drug if it is currently not on the formulary. Generally Providence ElderPlace will only approve your request for an exception if the alternative medications included on the formulary would not treat your condition as effectively and/or would cause you to have adverse medical effects. Coverage decisions will be made within 24 to 72 hours.
Are there other restrictions on coverage?
Providence ElderPlace requires prior authorization for certain medications. This means your primary care physician must get approval from Providence ElderPlace before the pharmacy will fill your prescription. The Prior Authorization Criteria (see attachment below) outlines most medications that require prior authorization.
How much will I pay for prescription medications?
ElderPlace participants are not charged co-payments or deductibles. There are no hidden costs.
How do I use the formulary?
The formulary is available as a downloadable PDF attachment below for your convenience (see Providence ElderPlace Formulary in the "Forms and Information" section).
The formulary list is in alphabetical order. The far right column of the formulary indicates whether ElderPlace must pre-authorize the medication.
Medicare Complaint Form
If you have complaints or concerns about Providence ElderPlace Plan and would like to contact Medicare directly please use the following link:
The Medicare Beneficiary Ombudsman
The Office of the Medicare Ombudsman (OMO) helps you with complaints, grievances, and information requests.
Do you need additional information?
If you have general questions about Medicare prescription drug coverage, please call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY/TDD users should call 1-877-486-2048 or visit www.medicare.gov.