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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.

Samaritan Choice Plans

2018 Samaritan Choice Formulary

Samaritan Employer Group Plans

2018 Small Group Formulary

2018 Large Group Formulary

InterCommunity Health Plans for InterCommunity Health Network CCO

2018 IHN-CCO Formulary

Samaritan Medicare Plans

Samaritan Advantage Health Plan HMO - Premier, Premier Plus Plans

2018 Premier Plan Formulary

2018 Premier Plan Plus Formulary

2018 Premier and Premier Plan Plus Prior Authorization Criteria

2018 Premier and Premier Plan Plus Formulary Quantity Limits

2018 Premier and Premier Plan Plus Formulary Step Therapy Criteria

Samaritan Advantage HMO - Special Needs Plan

2018 Special Needs Plan Formulary

2018 Special Needs Plan Prior Authorization Criteria

2018 Special Needs Plan Formulary Quantity Limits

2018 Special Needs Plan Formulary Step Therapy Criteria

2018 Special Needs Plan OTC Summary of Benefits

Request Rx 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.