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

The following changes to the drug list are effective February 22, 2017:

Formulary Additions

  • Clotrimazole, Entecavir, Doxycycline Hyclate, metoclopramide dispersible tablet add at Tier 1
  • Zurampic add at Tier 3 with preauthorization and quantity limit
  • Armodafinil add at Tier 1 with preauthorization and quantity limit
  • Namzaric add at Tier 3 with medical necessity preauthorization
  • Karbinal ER add at Tier 3 with medical necessity preauthorization
  • Lazanda add at Tier 3, SP with preauthorization
  • Lenvima add at Tier 3, SP with preauthorization and quantity limit
  • Relistor add at Tier 3 with preauthorization and quantity limit

Remove from Formulary

  • Roxicet solution; product discontinued consider oxycodone-acetaminophen
  • Zazole cream; product discontinued consider terconazole vaginal cream
  • Naftin cream; product discontinued consider naftifine cream

Tier Change

  • Baraclude, Rebetol, Epivir HBV, Gris-PEG, and Tamiflu from Tier 2 to Tier 3
  • Astepro from Tier 2 to Tier 3 with medical necessity preauthorization
  • Primaquine Phosphate from Tier 1 to Tier 2
  • Droxia from Tier 3 to Tier 2 
  • Budesonide suspension and Zazole cream from Tier 2 to Tier 1
  • Compro suppository, Nyamyc, Arbinoxa, and Ribasphere, from Tier 3 to Tier 1

Preauthorization Update

  • Vfend, Ancobon add preauthorization
  • Mentax, Namzaric, Extina foam, ketoconazole foam, Intermezzo sublingual tablet, and Luzu add medical necessity preauthorization

Step Therapy Update

  • Toviaz, Enablex, Myrbetriq, Darifenacin ER, Vesicare, Gelnique, Oxytrol, and Gralise add step therapy 

Quantity Limit Update

  • Duloxetine and Savella add quantity limit of 2 per day
  • Ambien, Edluar, zaleplon, eszopiclone, zolpidem, temazepam, zolpidem tartrate ER, Restoril, Lunesta add quantity limit of 1 per day
  • Fluconazole remove quantity limit
  • Coartem add quantity limit of 24 per 90 days
  • Combivent Respimat add quantity limit of 8 gram per 30 days
  • Alinia, Zolpimist solution add quantity 
  • See the PacificSource Drug Lists page for the current drug list

The following changes to the drug list are effective December 22, 2016:

Formulary Additions 

  • Alogliptin, Alogliptin-Metformin, Alogliptin-Pioglitazone add at Tier 1 with quantity limit
  • Bevespi Aerosphere add at Tier 3 with medical necessity preauthorization
  • Flurandrenolide add at Tier 1 with medical necessity preauthorization
  • Gleostine add at Tier 3
  • Horizant add at Tier 3 with step therapy
  • Jevantique Lo, Norethindrone-Eth Estradiol add at Tier 1
  • Metaxall, Metaxalone 400mg, Fyavolv add at Tier 1
  • Naftifine add at Tier 1
  • Tetrabenazine add at Tier 1 with preauthorization, specialty, quantity limit of 90 per 30 days
  • Tretinoin gel add at Tier 1 with preauthorization
  • Xiidra add at Tier 3 with medical necessity preauthorization
  • Zinbryta add at Tier 3 with medical necessity preauthorization, specialty

Remove from Formulary 

  • Lamisil packet; product discontinued consider terbinafine tablet
  • Lomustine; product discontinued consider Gleostine
  • Niravam dispersible tablet; product discontinued consider alprazolam

Tier Change 

  • Diazepam Intensol, Lorazepam Intensol, Sorine from Tier 3 to Tier 1
  • Tekturna, Dexilant from Tier 2 to Tier 3

Preauthorization Update 

  • Atralin gel, Revlimid add preauthorization
  • Butisol, Alprazolam Intensol, Seconal, alprazolam dispersible, Dutoprol, Treximet, Altoprev, Edarbyclor, Livalo add medical necessity preauthorization

Step Therapy Update 

  • Ranexa, Lyrica add step therapy

Quantity Limit Update 

  • Methylergonovine maleate add quantity limit of 28 per 180 days
  • Ninlaro add quantity limit of 3 per 28 days
  • Telmisartan-HCTZ, Telmisartan-amlodipine, Rifadin, Diovan HCT, Lotrel, Tekturna, Exforge, Exforge HCT, amlodipine-benazepril, amlodipine-valsartan, amlodipine-valsartan-HCTZ, amlodipine-atorvastatin, valsartan-hydrochlorothiazide, Lisinopril-hydrochlorothiazide, Rifampin, Benicar HCT, Azor, Tribenzor remove quantity limit
  • Xanax, Xanax XR, alprazolam XR, alprazolam, alprazolam ER, alprazolam dispersible tablet, Valium, diazepam, diazepam Intensol, diazepam solution, lorazepam Intensol, Lyrica, clonazepam, Ativan, lorazepam, Clorazepate, chlordiazepoxide, Klonopin, clonazepam, Tranxene-T, amphetamine-dextroamphetamine ER, amphetamine-dextroamphetamine, Zenzedi, Adderall XR, Adderall add quantity limit
  • Xenazine add quantity limit of 90 per 30 days

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

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

The following changes to the drug list are effective February 22, 2017

Formulary Additions

  • Entecavir, Terconazole cream, metoclopramide dispersible tablet add at Tier 1
  • Zurampic add at Tier 3 with preauthorization and quantity limit
  • Armodafinil add at Tier 1 with preauthorization and quantity limit
  • Lazanda solution add at Tier 3 with preauthorization and quantity limit
  • Lenvima add at Tier 4 with preauthorization and quantity limit
  • Soltamox add at Tier 3
  • Relistor add at Tier 3 with preauthorization and quantity limit

Removed from Formulary

  • Baraclude tablet; consider entecavir
  • Zymaxid ophthalmic solution; consider gatifloxacin ophthalmic solution
  • Celebrex; consider meloxicam, diclofenac, naproxen
  • Roxicet solution, consider oxycodone-acetaminophen solution
  • Lamisil packet; product discontinued, consider terbinafine
  • Tyzeka; consider adefovir, entecavir
  • Epivir HBV; consider lamivudine
  • Naftin cream; consider naftifine
  • Metformin ER (OSM); consider metformin, metformin ER (generic Glucophage products)
  • Acyclovir ointment; consider oral acyclovir, famciclovir, valacyclovir
  • Zazole cream; consider terconazole
  • Viramune XR; consider nevirapine ER
  • Cafergot, Ergomar; consider sumatriptan, rizatriptan, naratriptan
  • Pioglitazone-Glimepiride; consider pioglitazone and glimepiride separately
  • Ultresa; consider Creon, Zenpep
  • Hepsera; consider adefovir
  • Prevacid SoluTab; consider omeprazole, pantoprazole, lansoprazole
  • Metozolv ODT; consider metoclopramide

Tier Change

  • Strattera, Rapamune solution, Natacyn suspension, Noxafil, Rifater, Capastat, Complera, Sporanox, Edurant, Tabloid from Tier 2 to Tier 3
  • Tamiflu from Tier 2 to Tier 3 with quantity limit update; consider oseltamivir
  • Adefovir Dipivoxil from Tier 1 to Tier 4

Quantity Limit update

  • Alinia add quantity limit
  • Sancuso update quantity limit of 4 per 28 days
  • Triumeq add quantity limit of 1 per day
  • Emend, Anzemet update quantity limit
  • Coartem add quantity limit of 24 per 90 days
  • Fluconazole remove quantity limit

The following changes to the drug list are effective December 22, 2016:

Formulary Additions 

  • Add Finacea foam, Gleostine at Tier 3
  • Add Fyavolv at Tier 1
  • Add Jevantique Lo at Tier 0
  • Add Lynparza at Tier 4 with preauthorization
  • Add Tretinoin gel at Tier 1 with preauthorization

Removed from Formulary 

  • Tegretol-XR; consider carbamazepine ER
  • Xenazine; consider Tetrabenazine

Tier Change 

  • Diazepam Intensol from Tier 2 to Tier 1
  • Nicotrol, Nicotrol NS from Tier 3 to Tier 0
  • Rapamune solution from Tier 2 to Tier 3

Preauthorization update 

  • Metaxalone, Tizanidine capsule, Dexilant, Diflorasone diacetate add medical necessity preauthorization
  • Phenoxybenzamine add preauthorization
  • Zenzedi add preauthorization to new start between age 6 to 12

Quantity Limit update 

  • Lorazepam, Chlordiazepoxide with quantity limit update
  • Lyrica, Clonazepam add quantity limit
  • Ninlaro add quantity limit of 3 per 28 days
  • Ranexa add quantity limit of 2 per day
  • Tetrabenazine add quantity limit of 3 per day

See the PacificSource Drug Lists page for the current drug 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: (800) 624-6052, ext. 3784
  • Email: Use our online Contact Us form
Last updated 1/19/2017