2026 Prescription Drug 6-Tier Formulary
This document is the Providence Health Plan 2026 prescription drug formulary covering Formulary M, N/N-HSA, P/P-HSA; it lists covered drugs by therapeutic category, tier placement (0-6), and formulary restrictions (PA, QL, ST, S, LA, PV) and provides member/provider guidance on use of the formulary.
Formulary includes tier definitions, restriction abbreviations, and examples of QL/PA/ST/S/LA/PV usage.
Coverage Summary & Formulary Scope
Formulary Coverage Rules and Restrictions
Scope: This document is the Providence Health Plan 2026 Prescription Drug 6‑Tier Formulary. It describes the six-tier structure used across Providence formulary products (Formulary M, N/N‑HSA, P/P‑HSA) and summarizes how the Pharmacy & Therapeutics (P&T) Committee maintains and updates the formulary. It also explains what tiers mean, the common restriction abbreviations, and where to find plan‑specific exclusions and benefit exceptions.
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