Forms & Information

Forms Instructions

Providence ElderPlace formulary

Providence ElderPlace, in consultation with a team of health care providers, 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 two months.

Providence ElderPlace prior authorization criteria

Providence ElderPlace requires prior authorization for certain medications for participants. The Prior Authorization Criteria outlines most medications that require prior authorization.

Transition process for Medicare Part D

Providence ElderPlace will provide time for new participants to transition to our formulary. The Transition Process for Medicare Part D Policy describes the transition period and how participants can obtain a temporary supply of your drug if it is currently not on the formulary. For medications not on the ElderPlace formulary, participants and their primary care physician can ask Providence ElderPlace to make an exception.