Prescription Drug Information and News

Our PacificSource Drug Lists are updated monthly.
Learn more about our PacificSource Drug Lists >  

Our drug lists are available in a searchable online format.  Find a Drug >   

Preferred Drug List (PDL) Changes

September 2019. The following changes to the drug list are effective September 22, 2019:

Formulary Additions

  • Adapalene 0.1% pads add Tier 1 with medical necessity preauthorization
  • Beser Kit add Tier 3 with medical necessity preauthorization
  • Beser lotion add Tier 1 with medical necessity preauthorization
  • Bosentan tablet add Tier 1 with SP, quantity limit and preauthorization
  • Cinacalcet tablet add Tier 1 with SP and preauthorization
  • Cutaquig solution add Tier 3 with SP and preauthorization
  • Erlotinib tablet add Tier 1 with SP, quantity limit, partial fill and preauthorization
  • Fragmin solution add Tier 3
  • Ingrezza capsule add Tier 3 with medical necessity preauthorization
  • Insulin Lispro solution add Tier 1 with medical necessity preauthorization
  • Loteprednol ophthalmic suspension add Tier 1
  • Mesalamine capsule add Tier 1 with quantity limit and medical necessity preauthorization
  • Nucala solution/auto injector add Tier 3 with SP, quantity limit and preauthorization
  • Penicillamine capsule add Tier 1
  • Piqray dose pack add Tier 3 with SP and preauthorization
  • Pregabalin capsule/oral suspension add Tier 1 with quantity limit and step therapy
  • Qtern tablet add Tier 3 with medical necessity preauthorization
  • Ruzurgi tablet add Tier 3 with SP and preauthorization
  • Tuxarin ER tablet add Tier 3 with quantity limit
  • Zelnorm tablet add Tier 3 with medical necessity preauthorization
  • Zenevix pack add Tier 3 with medical necessity preauthorization
  • Zykadia tablet add Tier 3 with SP, partial fill, quantity limit and preauthorization

Step Therapy Update

  • Metaxalone tablet – add step therapy

Quantity Limit Update

  • Add quantity limit:
    • Edacrin tablet
    • Ethacrynic Acid tablet
    • Metaxalone tablet
    • Tyvaso solution (including Starter and Refill kits)
  • Update quantity limit:
    • Hydrocodone/Acetaminophen 7.5/325mg tablet
    • Zykadia Capsule

Preauthorization Updates

  • Add preauthorization:
    • Sensipar tablet
  • Remove preauthorization:
    • Metaxalone tablet

See the PacificSource Drug Lists page for the current drug list. 

August 2019. The following changes to the drug list are effective August 22, 2019:

Formulary Additions

  • Albuterol sulfate HFA inhaler add Tier 1 with quantity limit
  • Ambrisentan tablet add Tier 1 with SP, quantity limit and preauthorization
  • Chlorzoxazone tablet add Tier 3
  • Clobetasol emollient cream add Tier 1
  • Deferasirox tablet add Tier 1 with SP, partial fill and preauthorization
  • Duobril lotion add Tier 3 with medical necessity preauthorization
  • Dxevo 11 day pack add Tier 3
  • Erythromycin ethylsuccinate suspension add Tier 1
  • G-Levocarnitine oral solution add Tier 1
  • HiDex 6-day pack add Tier 1
  • Isopto atropine ophthalmic solution add Tier 3
  • Jynarque tablet add Tier 3 with limited access, quantity limit and preauthorization
  • Kalydeco packet add Tier 3 with SP, partial fill, quantity limit and preauthorization
  • Levocarnitine tablet add Tier 1
  • Lopreeza tablet add Tier 1
  • Rocklatan ophthalmic solution add Tier 3 with medical necessity preauthorization
  • Sevelamer tablet add Tier 1 with quantity limit
  • Vyndaqel capsule add Tier 3 with SP, quantity limit and preauthorization

Step Therapy Update

  • Enablex tablet – add step therapy
  • Lokelma – add step therapy
  • Rexulti tablet – update step therapy

Quantity Limit Update

  • Add quantity limit:
    • Belsomra
    • Dexcom G6 receiver
    • Dexcom G6 sensor
    • Freestyle Libre 14 day reader
    • Freestyle Libre 14 day sensor
    • Freestyle Libre reader
    • Freestyle Libre sensor
    • Intermezzo tablet
    • Oxazepam capsule
    • Samsca tablet
    • zolpidem sublingual tablet
  • Remove quantity limit:
    • citalopram tablet
    • desvenlafaxine ER tablet
    • escitalopram tablet
    • Fluoxetine capsule
    • paroxetine ER tablet
    • sertraline tablet
    • venlafaxine extended release (ER) capsule
  • Update quantity limit:
    • Lexapro
    • Paxil CR
    • Pexeva
    • Proair HFA
    • Proair Respiclick
    • Synjardy
    • Viibryd

Tier Update

  • EryPed oral suspension
  • Grastek
  • Odactra
  • Orilissa
  • Ragwitek

Preauthorization Updates

  • Add medical necessity preauthorization:
    • Hemangeol oral solution
    • methamphetamine tablet
    • Ondansetron 24mg tablet
  • Remove preauthorization:
    • Enablex tablet
    • Lokelma  
  • Glatopa – remove medical necessity (preauthorization remains)

Removed from Formulary

  • Kerlone tablet
  • Levatol tablet
  • Sectral capsule
  • Zebeta tablet

See the PacificSource Drug Lists page for the current drug list. 

August 2019. The following changes to the drug list are effective August 1, 2019:

Formulary Addition

  • Skyrizi prefilled syringe add Tier 3 with SP, quantity limit and preauthorization

Tier Update

  • Codeine sulfate 15mg tablet, Codeine sulfate 30mg tablet, Atropine sulfate ophthalmic solution, methylphenidate ER 72mg tablet – update tier

See the PacificSource Drug Lists page for the current drug list. 

State-based Drug List (ID, MT, OR, WA) Changes

September: All States

September 2019. The following changes to the drug list are effective September 22, 2019:

Formulary Addition

  • Cinacalcet tablet add Tier 4 with SP and preauthorization
  • Copaxone prefilled syringe add Tier 4 with SP, quantity limit and preauthorization
  • Cutaquig solution add Tier 4 with SP and preauthorization
  • Erlotinib tablet add Tier 4 with SP, quantity limit, partial fill and preauthorization
  • Framin add Tier 3 with SP, quantity limit and preauthorization
  • Gattex kit add Tier 4 with preauthorization
  • Loteprenol ophthalmic solution add Tier 1
  • Nucala solution add Tier 4 with SP, quantity limit and preauthorization
  • Piqray dose pack add Tier 4 with SP and preauthorization
  • Pregabalin capsule/oral suspension Tier 1 with step therapy
  • Ruzurgi tablet add Tier 4 with SP and preauthorization
  • Tyvaso solution add Tier 4 with SP, quantity limit and preauthorization
  • Zykadia tablet add Tier 4 with SP, partial fill, quantity limit and preauthorization

Quantity Limit Update

  • Add quantity limit:
    • Ethacrynic Acid tablet
    • Livalo Tablet
    • Metaxalone tablet
    • Paliperidone extended release tablet
    • Saphris tablet
    • Tyvaso starter kit
  • Update quantity limit:
    • Zykadia capsule

Step Therapy Update

  • Metaxalone tablet – Add step therapy

Preauthorization Update

  • Remove preauthorization:
    • Metaxalone tablet

Tier Update – for members older than 6 years of age

  • Fluorabon
  • Fluoritab
  • Ludent chewable tablet
  • Sodium Fluoride chewable tablet
  • Sodium Fluoride solution

Removed from Formulary

  • Lotemax suspension; consider loteprednol ophthalmic suspension
  • Lyrica capsule and oral suspension; consider pregabalin capsule and oral suspension
  • Sensipar tablet; consider cinacalcet tablet
  • Tarceva tablet; consider erlotinib tablet

See the PacificSource Drug Lists page for the current drug list.

August: All States

August 2019. The following changes to the drug list are effective August 22, 2019:

Formulary Addition

  • Albuterol HFA inhaler add Tier 1 with quantity limit
  • Ambrisentan tablet add Tier 4 with SP, quantity limit and preauthorization
  • Butalbital-acetaminophen tablet Tier 1 with quantity limit
  • Deferasirox tablet add Tier 4 with SP, partial fill and preauthorization
  • Erythromycin ethylsuccinate suspension add Tier 1
  • Fulphila add Tier 4 with SP and preauthorization
  • Glatopa prefilled syringe add Tier 3 with SP, quantity limit and preauthorization
  • G-Levocarnitine oral solution add Tier 1
  • Hydrocortisone valerate ointment add Tier 1
  • Jynarque tablet add Tier 4 with SP, limited access, quantity limit and preauthorization
  • Kalydeco packet add Tier 4 with SP, partial fill, quantity limit and preauthorization
  • Levocarnitine tablet add Tier 1
  • Lokelma packet add Tier 3 with step therapy
  • Lotemax SM opthalmic gel add Tier 3
  • Prenatal 19 chewable tablet add Tier 1
  • Sevelamer tablet add Tier 1 with quantity limit
  • Sodium polystyrene suspension add Tier 1
  • Vyndaqel capsule add Tier 4 with SP, quantity limit and preauthorization

Quantity Limit Update

  • Add quantity limit:
    • Dexcom G6 receiver
    • Dexcom G6 sensor
    • Freestyle Libre 14 day Reader
    • Freestyle Libre 14 day Sensor
    • Freestyle Libre Reader
    • Freestyle Libre Sensor
  • Remove quantity limit:
    • desvenlafaxine ER tablet
    • duloxetine capsule
    • Fluvoxamine tablet
    • paroxetine ER tablet
    • sertraline tablet
    • venlafaxine extended release (ER) capsule
  • Update quantity limit:
    • Methylphenidate ER (LA) capsule
    • ProAir HFA
    • ProAir Respiclick
    • Synjardy tablet

Step Therapy Update

  • Rexulti – update step therapy

Preauthorization Update

  • Methamphetamine tablet – add medical necessity preauthorization
  • Zileuton ER tablet – add medical necessity preauthorization

Tier Update

  • Grastek – update tier
  • Odactra – update tier
  • Orilissa – update tier
  • Ragwitek – update tier

Removed from Formulary

  • EryPed suspension; consider erythromycin ethylsuccinate suspension
  • Exjade tablet; consider deferasirox tablet
  • Letairis tablet; consider ambrisentan tablet
  • Ondansetron 24mg tablet; consider ondansetron 4mg or 8mg tablet
  • Renagel tablet; consider sevelamer tablet

See the PacificSource Drug Lists page for the current drug list. 

August 2019. The following changes to the drug list are effective August 1, 2019:

Formulary Addition

  • Skyrizi prefilled syringe add Tier 4 with SP, quantity limit and preauthorization

Tier Update

  • Codeine sulfate 15mg tablet, Codeine sulfate 30mg tablet, Atropine sulfate ophthalmic solution, methylphenidate ER 72mg tablet – update tier

See the PacificSource Drug Lists page for the current drug list. 

Non-FDA Approved Compounding Agents

A compounded medication is when a pharmacist combines multiple ingredients together. Compounded claims often use what we called "bulk powders." These powders act as a mixing agent/congealing agent to hold the finished product together. These ingredients may not always be approved by the Food and Drug Administration (FDA), thus may not have been reviewed for safety and efficacy. To ensure you are taking medications proven to be safe and effective, beginning August 1, 2017, the non-FDA approved ingredients will be removed from coverage on your plan.

Examples of common non-FDA approved agents:

  • Cellulose (bulk) powder
  • Alcohol, usp 95%
  • Cream base
  • Fatty acid base
  • Gelatin capsules (empty)
  • Hypromellose (bulk) powder
  • Hormone cream base
  • Propylene glycol liquid
  • Thyroid powder
  • Silica gel
  • Stevia (bulk) powder
  • Vitamin E acetate (bulk) liquid

See the non-FDA approved bulk powder agents for the full list >

“Partial Fill” Lets a Patient Test a New Prescription

As you know, some drugs not only have a high cost, but have side effects that make them hard to tolerate for long-term use. Beginning February 22, 2016, these medications will be dispensed in a limited amount, on the first fill only, for half the normal copay. This “partial fill” will act as a trial period to see if the patient is able to successfully take the drug. 

A week into the first fill, a Caremark Specialty Care Team pharmacist or nurse will contact the patient. They will check on side effects and see if the patient was able to tolerate the drug. The Care Team will also answer questions and concerns about the treatment. If the trial period is a success, the patient will continue the drug. After this initial trial, all future fills will be for the full amount. 

On our drug lists, partial-fill drugs are identified by “Partial Fill” in the Restrictions column.

Partial-fill drugs include:

  • Afinitor
  • Bosulif
  • Erivedge
  • Gleevec
  • Inlyta
 
  • Jakafi
  • Nexavar
  • Odomzo
  • Sprycel
  • Sutent
 
  • Tafinlar
  • Tarceva
  • Targretin
  • Tasigna
  • Votrient
 
  • Xalkori
  • Xtandi
  • Zolinza
  • Zykadia
  • Zytiga
 

Preauthorization and Step Therapy Drug Lists with Criteria

Our Preauthorization Policies and Step Therapy Policies documents contain lists of drugs that require preauthorization or that are Step Therapy drugs, as well as their criteria. These two documents replace the one-page "PDL/VDL Preauthorization and Step Therapy Drug Lists" document. You may also use Preauthorization Policies to access our coverage rules for compound medications.

Flu and Pertussis Vaccination Coverage

Our flu vaccination page now includes information about your coverage for whooping cough (pertussis), as well as seasonal flu vaccination and general information.

Consumer Updates from the FDA

Quick Links

PacificSource Drug Lists—our comprehensive drug list page

Preventive Drug List

Incentive Drug List

Prescription drug claim form

Prescription Drug Preauthorization Request (Fax)

InTouch for Members

Are you a Medicare or Medicaid member?

If so, we have a website just for you!

Cool Tools for Managing Your Rx

On the CVS Caremark® website, you'll find tools to help you track pharmacy expenses, save on drug costs, manage your prescriptions, and more. Register by using the member ID number and group code on your ID card. To start, visit Caremark.com.

Why Choose Generics?

Generic prescription medicines are safe, effective, and a good value. Save money by using them instead of brand name drugs whenever possible.

Questions?

Contact our Pharmacy Services Department:

  • Phone: (541) 225-3784
  • Toll-free: (844) 877-4803
  • Email: Use our online Contact Us form
Last updated 8/20/2019