The guide is a single resource you can use to take an active role in your health and engage with your health plan. It provides useful information about myProvidence, care options, and other programs available for PHP members. 

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Member ID card

Carry your member ID card with you as you’ll need it when you receive services. It includes important information, including your name, member ID number, medical plan, network information and important phone numbers.

2025 Benefit summaries

• 2025 OnPoint HSA (PDF)
• 2025 OnPoint PREM (PDF)
• 2025 OnPoint Rx (PDF)

2024 Benefit summaries

• 2024 OnPoint HSA (PDF)
• 2024 OnPoint PREM (PDF)
• 2024 OnPoint RX (PDF)

We know behavioral health care isn’t a one-size-fits-all solution. We’re all unique, and our journey and needs vary depending on our personal situation. At Providence, we want that lens to drive us when looking at the mix of services and solutions we offer for your well-being. Whether you’re looking for some support to relax, ready to try self-directed therapy that helps you to engage when you feel like it, or looking for immediate connection to a provider – via text, voice, video or face to face – we have many options to fit your needs.

Formulary

Providence Health Plan provides a comprehensive prescription drug formulary designed to promote safe, effective and affordable drug therapy.

Tips to help you save when you need a prescription

• Choose generics when possible.
• Use an in-network retail pharmacy. Search the online provider directory to find an in-network pharmacy near you.
• Fill maintenance medications (medications taken on a regular, recurring basis for a chronic or long-term health condition) at preferred retail or mail-order pharmacy. You can purchase up to a 90-day supply.
• Have certain medications pre-authorized before they are filled.
• The $0 Preventive Medication List is made up of drugs that can be considered “first-line” to prevent the onset of a disease or medical condition(s) and can help maintain health and wellbeing.

Participating pharmacies

As a member, you have access to more than 34,000 participating pharmacies, including retail, preferred retail, mail-order and specialty. Find one in our online provider directory.

Mail-order pharmacy:

Postal Prescription Services
Website: www.ppsrx.com
503-797-2100 or 800-552-6694
Monday to Friday, 6 a.m. to 6 p.m.; Saturday, 9 a.m. to 2 p.m. (Pacific Time)
Mailing address: P.O. Box 2718, Portland, OR 97208
Automated refill line available 24/7, 365 days a year: 800-552-6694

Pharmacy FAQ

Get answers to frequently asked questions about prescription drug coverage, prior authorization, using the formulary, and specialty medication.

Costco Home Delivery

As a Providence Health Plan member, you have access to full-service mail-order prescription services through Costco Home Delivery. Costco Home Delivery offers affordable prescriptions, outstanding customer service and free standard shipping on all orders. You may also call a pharmacist for consultation any time during business hours.

Who is eligible?

Costco Home Delivery will verify your eligibility when you register. All covered members and their qualified dependents have access to this mail order pharmacy. For non-Medicare and non-Medicaid plans, your network provisions may require the use of just one mail order pharmacy for coverage. Please call the Providence Health Plan Pharmacy Department at 877-216-3644 if you have questions.

Order prescriptions by mail

• Register with Costco Home Delivery online at www.costco.com/Pharmacy/home-delivery
• Costco pharmacy agents are available at 800-607-6861, 5 a.m. to 7 p.m. (Pacific Time), Monday - Friday, 9:30 a.m. to 2 p.m. (Pacific Time), Saturday
• Your doctor may also fax in new or refill orders at 800-633-0334
• Refer to your prescription drug benefit summary for plan details

Costco contacts, FAQ, and how-to guide

• www.costco.com/Pharmacy/home-delivery
• Costco FAQ

Contact information

Mon – Fri 5 a.m. to 7 p.m. PT, Sat 9:30 a.m. to 2 p.m. PT,
Pharmacy is available 24/7 to refill prescriptions, order new prescriptions and check prescription status.

Phone:
800-607-6861

Fax:
800-633-0334

Mailing address:
802 134th St. SW Ste 140, Everett, WA 98204-7314

Contact Costco Home Delivery Pharmacy email:

mail to: webpharmacy@costco.com

Costco Home Delivery contracts with Providence Health Plan as a participating pharmacy for members. You are responsible for arrangement of services and/or payment of services directly to Costco Home Delivery.

Rx Savings Solutions 

Providence Health Plan partners with Rx Savings Solutions to provide a free, confidential service to help you save money on prescriptions. This new service is linked to your health plan, so everything is personalized for your medications and insurance. Rx Savings Solutions alerts you via mail, email, phone call, or text (if you enroll in SMS messaging) if you have an opportunity to save on your prescription. A team of certified pharmacy technicians and pharmacists help walk you through every step of the process.

IMPORTANT NOTE: This program is open to all members of Individual & Family plans. For those with employer-provided health plans, availability is determined on a case-by-case basis and should be coordinated with your Human Resources team. Eligible participants will also receive direct communication from Rx Savings Solutions. 

Your login depends on the plan you have. If you have an ID card that looks like this (please note the specific logo), use the Rx Savings Solutions portal weblink below.

Set up your account today: Go to myrxss.com/ProvidenceHealthPlan or call 800-268-4476 (TTY 800-877-8973), Monday through Friday, 5 a.m. to 6 p.m. (Pacific Time).

Get started today to see how you can save! Here’s how it works:

• Rx Savings Solutions uses software connected to your health plan. It looks at all the medications you take and finds options that may save you money.
• Your online account shows which lower-cost prescriptions may be available under your insurance plan and lets you compare prices. It also automatically lists all medications you’ve filled so everything is in one place.
• Rx Savings Solutions will contact you anytime you can be spending less.
• Switch to a lower-cost option with ease. At your request, the Rx Savings Solutions pharmacy support team is available to work with your doctor and pharmacy to help you switch to lower cost drugs, pharmacies, or mail order pharmacy.

Learn more about Rx Savings Solutions here.

Smart RxAssist^TM

A program that may help you lower your copay cost on certain high-cost medications.

Smart RxAssist may reduce your copay to $0 on select specialty medications. Eligible members* are enrolled automatically. A specialized patient navigator will assist you every step of the way.

Program Features and Eligibility 

The Smart RxAssist program may help lower your out-of-pocket costs to $0 for eligible specialty medications. In some cases, you may have a small fee which you will be reimbursed for via check within 45 days.

• There is no cost to members for participating in the Smart RxAssist program.
• The medications currently eligible for the Smart RxAssist program are listed below. Medications eligible for the program are subject to change.
• Because this program provides a $0 cost not subject to deductible, the tax laws regarding a health savings account makes the program unavailable to those enrolled in a Health Savings Account (HSA) medical plan.

Smart RxAssist Program List

*HSA, Medicare, Medicaid, Members 65 years and older, and Washington plan-based members are ineligible for the Smart RxAssist Program.

Certain services require a prior authorization before you receive care, meaning that before you receive care, the service must be pre-approved by Providence Health Plan. Here’s what you should know about prior authorization:

Certain services need to be approved before you receive them from a health care provider.
Sometimes you need to get the prior authorization; sometimes your provider will get the approval. 

Make sure to discuss prior authorization with your provider when you are considering one of the following procedures:

• Inpatient hospital admissions, including maternity
• High tech diagnostic imaging, such as MRI, MRA, SPECT, CT, CTA, PET, Nuclear Cardiology (Carelon Medical Benefits Management (formerly American Imaging Management) authorizes these services; contact Carelon at 800-920-1250)
  
  
  • Effective March 1, 2023, American Imaging Management/AIM Specialty Health and Beacon Health Options changed their names to Carelon. AIM transitioned to Carelon Medical Benefits Management, and Beacon Health Options transitioned to Carelon Behavioral Health. If you have questions about this change, please call 800-878-4445 or click here to learn more.
• Mental Health and/or Chemical Dependency services (PBH, a team of experts in mental health – sometimes called "behavioral health," is the authorizing agent: 800-711-4577)
• Outpatient Rehab for Physical and Occupational Therapy: 866-803-8052 www.evicore.com/pages/ProviderLogin.aspx
• Select outpatient procedures, included but not limited to these categories:
  
  
  • Miscellaneous cosmetic, reconstructive, nasal, oral/dental/orthognathic procedures
  • Cervical, thoracic and lumbar spinal surgeries
  • All bariatric services
  • Organ/tissue and bone marrow transplants (including pre-transplant evaluations and HLA typing)
  • Uvulectomy, uvulopalatophyaryngoplasty (UPPP), laser-assisted uvulopalatoplasty (LAUP)
  • Select hip, knee and shoulder procedures
  • Sleep studies and/or treatment of sleep disorders
• Skilled nursing facility admissions
• Inpatient rehabilitation facility admissions
• Inpatient hospice
• Pulmonary rehabilitation
• Cardiac rehabilitation
• General anesthesia for dental services
• Procedures/surgeries/treatment that may be considered experimental or investigational
• Genetic testing (Cytogenetic Studies) and counseling
• Prosthetics
• Select Durable Medical Equipment including but not limited to the following categories:
  
  
  • Power-wheel chairs & supplies
  • Seat Lift Mechanisms
  • Select nerve stimulators
  • Skin substitutes
  • Oral appliances
  • Flexion/Extension devices
  • Wound Therapy pumps
  • Speech Generating devices
  • Purchase of CPAP post trial rental period
• Select injectable medications also require prior authorization. See your pharmacy medical services prior-authorization list (PDF) for details.
  
  

The list of services needing prior authorization is not exhaustive. For a complete list of services that require prior authorization, please contact PHP customer service at 800-878-4445.

Important information about how prior authorization works

Talk with your provider about getting prior authorization. Many times a provider will obtain the prior authorization on your behalf. You can call Providence Health Plan customer service at 800-878-4445 to verify if prior authorization has been obtained. If you do not obtain prior authorization for services received from an out-of-network provider, a financial penalty may apply.

The following tips can help you stay well and save on health care costs.

Tip 1: Use your preventive care benefits
Your plan covers certain preventive services in full when received from an in-network provider.

Tip 2: Choose in-network providers and pharmacies
Refer to the online provider directory to locate in-network providers and participating pharmacies.

Tip 3: Use preferred retail or mail order pharmacies to fill 90-day supplies of maintenance medication
Purchase up to a 90-day supply of maintenance medications using a participating mail-order pharmacy or a preferred retail pharmacy. Not all drugs are considered maintenance prescriptions, including compounded drugs, drugs from specialty pharmacies and oncology drugs. Learn more about this in the pharmacy resources section of this page.

Tip 4: Access the most appropriate care
Knowing when and where to get care is essential to your health and your wallet.
Learn about your care options here.

Tip 5: Compare costs
Before receiving care, log in to myProvidence and use the treatment cost calculator to learn about a facility or doctor, and the estimated costs of your treatment. You can also compare medical facilities to make sure you’re getting the best care at the best price. The costs are customized to you based on your plan benefits, the providers in your plan’s network and how much you’ve accumulated toward your deductible and out-of-pocket maximum.

Extra values and discounts

You can enjoy many perks when you’re enrolled in a Providence Health Plan. Here are just a few extras values and discounted services just for members.

ProvRN offers 24/7 medical advice from registered nurses who can evaluate your symptoms to help determine your next steps for care. Exclusive to Providence Health Plan members, it's free and available when you need it. Contact ProvRN by phone at 503-574-6520 or 800-700-0481 (TTY: 711).

LifeBalance offers savings on health club memberships, fitness classes, massage therapy, weight loss programs, recreational, cultural and wellness events, family activities, movies, travel and more. Log in or register for a free myProvidence account to access discounts through LifeBalance.

TruHearing provides members (including parents and grandparents) with significant discounts on digital hearing aids. The TruHearing program includes a free hearing screening, 45-day money-back guarantee, three-year warranty, one-year supply of batteries and 12 months of no-interest financing upon approved credit. This program is not a covered benefit under your medical health plan, but is an employee extra value service. Visit www.truhearing.com or call TruHearing at 877-253-4040 to find the nearest provider.

Wellness resources

Smoking cessation
Smoking is a powerful addiction. Quitting takes practice, patience and support. You can get the help you need with one of our award-winning support groups and telephone counseling programs:

• Tobacco quit line - A free telephone service to help you develop a personalized quit plan and find counseling and resources in your area. Call 1-800-QUIT-NOW or 877-2NO-FUME (Spanish).
• Free & Clear - A telephone-based program designed for smokers who want a structured program, but cannot attend regular classes. Call 800-292-2336.