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View and Search Plan Formularies

Samaritan Health Plans maintains a committee composed of physicians and pharmacists whose purpose is to review scientific evidence and decide which medications should be added or deleted from our formularies. See below for our plans’ formularies.

Search Capabilities

The search tool below allows searches by medication name or type. Search results include:

  • The copay (amount) or coinsurance (percentage) that the member will be required to pay for the drug;
  • Any restrictions for the drug, such as prior authorization, quantity limits or step therapy requirements;
  • The effective date of the formulary and the date it was last updated.

Mobile device users should use this link for best search experience.

Download and print the Samaritan Choice Plans Formulary.

Need to request a prior authorization? Download our prior authorization form.

Samaritan Employer Group Plans - Standard, Health & Wellbeing, New Performance, Everyday Choices, Momentum Plans

2018 Small Group Formulary for Standard, Health & Wellbeing, New Performance Plans

2018 Large Group Formulary for Everyday Choices and Momentum Plans

InterCommunity Health Plans for InterCommunity Health Network CCO

Request Prior Authorization

Select medications may require prior authorization. A physician or member may request authorization.

Talk with our Provider Services representatives 

call us at 541-768-5207 1-888-435-2396 8 a.m. to 6 p.m.
Mon. - Fri.