Prescription Drug Information and News

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

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

Preferred Drug List (PDL) Changes

December 2019 Drug List Change Notification for changes effective December 22, 2019. Note: Starting with December 2019 drug list changes, we will notify you of the monthly changes 60 days in advance. The notification will contain changes for the Preferred and state-based lists.

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

Formulary Additions

  • Baqsimi nasal powder add Tier 2 with quantity limit
  • Bio-Statin capsule add Tier 2
  • Cefixime capsule add Tier 1
  • Corlanor solution add Tier 3 with SP and preauthorization
  • Corvita tablet add Tier 3
  • Diphenhydramine injection and capsule add Tier 1
  • Dupixent add Tier 3 with SP, quantity limit and preauthorization
  • Evekeo ODT tablet add Tier 3 with quantity limit and preauthorization
  • Febuxostat tablet add Tier 1 with step therapy
  • Ferriprox tablet and solution add Tier 3 with SP and preauthorization
  • Icatibant solution add Tier 1 with SP and preauthorization
  • Katerzia suspension add Tier 3
  • Metaxall CP kit add Tier 3 with medical necessity preauthorization
  • Mircera solution add Tier 3 with SP
  • Norgesic Forte tablet add Tier 3 with medical necessity preauthorization
  • Nubeqa tablet add Tier 3 with quantity limit and preauthorization
  • Parlodel tablet add Tier 3
  • Purixan suspension add Tier 3 with SP and medical necessity preauthorization
  • Rinvoq tablet add Tier 3 with SP, quantity limit and preauthorization
  • Sovaldi tablet add Tier 3 with SP and medical necessity preauthorization
  • Symjepi solution add Tier 2 with quantity over time limit
  • Turalio capsule add Tier 3 with SP, quantity limit and preauthorization
  • Vyleesi solution add Tier 3 with quantity limit and preauthorization

Step Therapy Update

  • Remove step therapy
    • Amitiza capsule
    • Jentadueto tablet
    • Jentadueto XR tablet
    • Tradjenta tablet

Quantity Limit Update

  • Add quantity limit:
    • AirDuo Respiclick inhaler
    • Albuterol sulfate nebulizer solution
    • Arcapta neohaler capsule
    • Arnuity Ellipta inhaler
    • Cromolyn nebulizer solution
    • Evekeo tablet
    • Fluticasone-salmeterol inhaler
    • Ipratropium-albuterol nebulizer solution
    • Levalbuterol inhaler
    • Levalbuterol nebulizer solution
    • Mayzent tablet
    • Serevent Diskus
    • Targretin gel
    • Viibryd tablet
    • Xolair solution
    • Xopenex HFA inhaler
  • Remove quantity limit:
    • Depakote ER tablet
    • Divalproex ER tablet
  • Update quantity limit:
    • Asmanex
    • Promacta 75mg tablet

Tier Update

  • Bexarotene capsule
  • BP Vit 3 capsule
  • Chlorzoxazone 250mg tablet
  • C-Nate DHA
  • CompleteNate tablet
  • Corvita 150 tablet
  • Corvite Fe tablet
  • Corvite Free tablet
  • Elite-OB tablet
  • FerraPlus 90 tablet
  • Ferrocite plus tablet
  • Hemocyte-F tablet
  • Inatal GT tablet
  • Linzess capsule
  • MVC-fluoride tablet
  • Mynatal Plus tablet
  • Mynatal-Z tablet
  • PNV OB+DHA pack
  • PNV-DHA+docusate capsule
  • Prenaissance Balance tablet
  • Prenaissance capsule
  • Prenaissance Harmony DHA pack
  • Prenaissance Next tablet
  • Prenaissance Next_B tablet
  • Prenaissance plus capsule
  • Revonto solution
  • RyClora solution
  • Targretin capsule
  • Taron Forte capsule
  • Theochron tablet
  • TL-select capsule
  • Trelegy Ellipta inhaler
  • Virt-PN DHA capsule
  • Virt-PN plus capsule
  • Virt-PN tablet
  • Virt-Select capsule
  • VP-CH plus capsule
  • VP-CH-PNV capsule
  • VP-Heme OB + DHA tablet

Preauthorization Updates

  • Add preauthorization:
    • Amitiza capsule (medical necessity)
    • Ancobon capsule (medical necessity)
    • Carticel implant (medical necessity)
    • Jentadueto tablet (medical necessity)
    • Jentadueto XR tablet (medical necessity)
    • Lialda capsule (medical necessity)
    • Suboxone film (medical necessity)
    • Targretin gel
    • Tradjenta tablet (medical necessity)
    • Tudorza Pressair inhaler (medical necessity)
  • Remove preauthorization:
    • Itraconazole solution
    • Xiidra solution

Removed from Formulary (Inactive or discontinued medications)

  • Amphotec suspension
  • Arbinoxa solution
  • Arbinoxa tablet
  • Avadamet tablet
  • Avandia tablet
  • Cedax suspension
  • Ceftin tablet
  • Clemastine syrup
  • Diabeta tablet
  • ED Cyte F tablet
  • Factive tablet
  • Foradil capsule
  • Grifulvin V tablet
  • Ilotycin ointment
  • Inatal Advance tablet
  • Maxaron Forte tablet
  • Mefoxin solution
  • Na Ferric Gluc Cpix in sucrose (IV solution)
  • Neumega solution
  • Norflex solution
  • Orphenadrine-aspirin-caffeine tablet
  • Prandimet tablet
  • Prandin tablet
  • Prenaissance DHA pack
  • Prenaissance Promise pack
  • PreQue 10 tablet
  • Pulmophylline pack
  • Respa-BR tablet
  • Rocephin solution
  • Spectracef tablet
  • Vexol suspension
  • Zinbryta solution

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

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

Formulary Additions

  • Adhansia XR capsule add Tier 3 with quantity limit and preauthorization
  • Ammonium lactate cream 12% add Tier 1
  • Ammonium lactate lotion 12% add Tier 1
  • Annovera ring add Tier 0 (ACA drug, limits apply)
  • Ciclodan solution kit 8% add Tier 3
  • Dotti patch add Tier 1
  • Doxylamine-pyridoxine delayed release tablet add Tier 1
  • Egaten tablet add Tier 3 with quantity limit over time and medical necessity preauthorization
  • Emgality 300mg syringe add Tier 3 with quantity limit and preauthorization
  • Erythromycin delayed release tablet add Tier 1
  • Ezallor sprinkle capsule add Tier 3 with quantity limit
  • Fentanyl citrate buccal tablet add Tier 1, with quantity limit and preauthorization
  • Inflatherm kit add Tier 3 with medical necessity preauthorization
  • LMR plus kit add Tier 3 with medical necessity preauthorization
  • Methoxsalen capsule add Tier 1
  • Oxandrolone tablet add Tier 1
  • Pyridostigmine tablet add Tier 3
  • Quinosone kit add Tier 3 with medical necessity preauthorization
  • Ramelteon tablet add Tier 1 with quantity limit and step therapy
  • Retin-A Micro Pump 0.06% add Tier 3 with medical necessity preauthorization
  • Retin-A Micro Pump 0.08% add Tier 3 with medical necessity preauthorization
  • Sildenafil suspension add Tier 1 with SP and preauthorization
  • Slynd tablet add Tier 0 (ACA drug, limits apply)
  • Sunosi tablet add Tier 3 with quantity limit and preauthorization
  • Symdeko therapy pack add Tier 3 with SP, quantity limit and preauthorization
  • Thiola EC tablet add Tier 3 with medical necessity preauthorization
  • Varophen kit add Tier 3 with medical necessity preauthorization
  • Ximino extended release capsule add Tier 3 with medical necessity preauthorization
  • Xpovio therapy pack add Tier 3 with SP, quantity limit and medical necessity preauthorization

Quantity Limit Update

  • Update quantity limit:
    • Adderall 20mg tablet
    • Amphetamine-Dextroamphetamine 20mg tablet
    • Tetrabenazine tablet

Preauthorization Updates

  • Add preauthorization:
    • Demser capsule (medical necessity)
    • Fabior Foam (medical necessity)
    • Sorilux foam (medical necessity)
    • Temodar capsule
    • Temozolomide capsule
    • Zytiga tablet (medical necessity)
  • Remove preauthorization:
    • Acitretin capsule
    • Ketoconazole foam
    • Soriatane capsule
    • Ultravate lotion

Tier Update

  • Avita cream
  • Avita gel
  • Benziq Wash liquid
  • Calcitrene ointment
  • Ciclodan cream
  • Ciclodan solution
  • DexPak
  • Differin lotion
  • Nystop powder
  • Physicians EZ Use M-Pred kit
  • Retin-A micro gel
  • Rosadan cream
  • Rosadan gel
  • TaperDex pack
  • Thermazene cream
  • Tretinoin microsphere gel
  • Triderm Cream
  • Zaclir cleansing lotion

Removed from Formulary

  • 8-Mop capsule
  • Amturnide tablet
  • Aristospan intralesional suspension
  • Clindamax gel
  • CNL8 nail kit
  • Cutivate cream
  • Flo-Pred suspension
  • HyGel
  • Isoptin SR tablet
  • LoKara lotion
  • Melquin 3% solution
  • Pediaderm AF complete kit
  • Pediaderm HC kit
  • Pediaderm TA kit
  • Sulfoam shampoo
  • Tri-Luma cream
  • Xenaderm ointment

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

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

Removed from Formulary:

  • CAVAREST GEL 1.1 %
  • CAVIRINSE SOLUTION 0.2 %
  • CLINPRO 5000 PASTE 1.1 %
  • CONTROLRX CREAM 1.1 %
  • DENTA 5000 PLUS CREAM 1.1 %
  • DENTAGEL GEL 1.1 %
  • FLUORIDEX DAILY DEFENSE GEL 1.1 %
  • FLUORIDEX ENHANCED WHITENING GEL 1.1 %
  • FLUORIDEX SENSITIVITY RELIEF PASTE 1.1-5 %
  • GEL-KAM ORAL CARE RINSE CONCENTRATE 0.63 %
  • NAFRINSE DAILY/NEUTRAL SOLUTION RECONSTITUTED 0.05 %
  • NEUTRAGARD ADVANCED GEL 1.1 %
  • PHOS-FLUR GEL 1.1 %
  • PREVIDENT 5000 BOOSTER PASTE 1.1 %
  • PREVIDENT 5000 BOOSTER PLUS PASTE 1.1 %
  • PREVIDENT 5000 DRY MOUTH GEL 1.1 %
  • PREVIDENT 5000 ENAMEL PROTECT PASTE 1.1-5 %
  • PREVIDENT 5000 PLUS CREAM 1.1 %
  • PREVIDENT 5000 SENSITIVE PASTE 1.1-5 %
  • PREVIDENT GEL 1.1 %
  • PREVIDENT SOLUTION 0.2 %
  • sf 5000 plus cream 1.1 %
  • sf gel 1.1 %

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

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

December 2019 Drug List Change Notification for changes effective December 22, 2019. Note: Starting with December 2019 drug list changes, we will notify you of the monthly changes 60 days in advance. The notification will contain changes for the Preferred and state-based lists.

November: All States

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

Formulary Additions

  • Baqsimi nasal powder add Tier 2 with quantity limit
  • Cefixime capsule add Tier 1
  • Corlanor solution add Tier 3 with preauthorization
  • Erythromycin DR tablet add Tier 1
  • Febuxostat tablet add Tier 1 with step therapy
  • Ferriprox tablet and solution add Tier 4 with SP and preauthorization
  • Icatibant solution add Tier 4 with SP and preauthorization
  • Nubeqa tablet add Tier 4 with SP, quantity limit and preauthorization
  • Rinvoq tablet add Tier 4 with SP, quantity limit and preauthorization
  • Symjepi solution add Tier 2 with quantity over time limit
  • Tremfya solution add Tier 4 with SP, quantity limit and preauthorization
  • Turalio capsule add Tier 4 with SP, quantity limit and preauthorization
  • Xiidra solution add Tier 2

Quantity Limit Update

  • Add quantity limit:
    • Glucagon emergency kit
    • Mayzent tablet
    • Promacta 75mg tablet
    • Targretin gel
  • Remove quantity limit:
    • Divalproex ER tablet
  • Update quantity limit:
    • Albuterol nebulizer solution
    • Asmanex HFA inhaler
    • Breo Ellipta inhaler
    • Budesonide nebulizer solution
    • Combivent Respimat inhaler
    • Cromolyn nebulizer solution
    • Fluticasone-Salmeterol inhaler
    • Ipratropium-albuterol nebulizer solution
    • Levalbuterol inhaler
    • Levalbuterol nebulizer solution
    • Pulmicort Flexhaler
    • Serevent Diskus inhaler
    • Trelegy Ellipta inhaler

Tier Update

  • Aubagio tablet
  • Linzess capsule
  • Mayzent tablet

Preauthorization Updates

  • Remove preauthorization:
    • Daliresp tablet
    • Itraconazole solution

Removed from Formulary

  • Amitiza capsule; consider lactulose or Linzess capsule
  • Firazyr solution; consider icatibant solution
  • Jentadueto tablet; consider metformin, metformin ER, alogliptin-metformin, Janumet
  • Jentadueto XR tablet; consider metformin, metformin ER, alogliptin-metformin, Janumet XR
  • Polyethylene Glycol 3350 powder
  • Suprax capsule; consider cefixime capsule
  • Tradjenta tablet; consider metformin, metformin extended release (ER), alogliptin, Januvia
  • Tudorza Pressair inhaler; consider Atrovent HFA, Spiriva Handihaler, Spiriva Respimat
  • Uloric tablet; consider allopurinol, probenecid, probenecid- colchicine, febuxostat tablet

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

October: All States

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

Formulary Addition

  • Acyclovir cream add Tier 1 with quantity limit and step therapy
  • Acyclovir ointment add Tier 1 with step therapy
  • Annovera vaginal ring add Tier 0 (ACA drug, limits apply)
  • Dotti patch add Tier 1
  • Emgality 300mg syringe add Tier 3 with quantity limit and preauthorization
  • Fentanyl citrate buccal tablet add Tier 1 with quantity limit and preauthorization
  • Ramelteon tablet add Tier 1 with quantity limit and step therapy
  • Slynd tablet add Tier 0 (ACA drug, limits apply)
  • Stimate solution add Tier 4 with preauthorization
  • Sunosi tablet add Tier 3 with quantity limit and preauthorization
  • Symdeko therapy pack add Tier 4 with SP, quantity limit and preauthorization
  • Testosterone gel 1.62% add Tier 1 with quantity limit and preauthorization
  • Viibryd starter pack add Tier 3 with quantity limit and step therapy

Quantity Limit Update

  • Add quantity limit:
    • Viibryd tablet
  • Update quantity limit:
    • Amphetamine-dextroamphetamine 20mg tablet
    • Jynarque therapy pack
    • Tetrabenazine tablet

Step Therapy Update

  • Mirvaso gel – Add step therapy

Preauthorization Update

  • Add preauthorization:
    • Fluorouracil 0.5% cream (medical necessity)
    • Veregen ointment
  • Remove preauthorization:
    • Acitretin capsule
    • Mirvaso gel

Tier Update

  • Nitroglycerin solution

Removed from Formulary

  • 8-Mop capsule; consider methoxsalen capsule
  • Denavir cream; consider oral acyclovir capsule or tablet, valacyclovir tablet, famciclovir tablet, acyclovir ointment, acyclovir cream
  • Fentora tablet; consider oxycodone tablet, morphine sulfate tablet, hydromorphone tablet, fentanyl citrate buccal tablet
  • Hydrocortisone suppository; consider proctocare-HC cream, hydrocortisone cream, proctosol HC cream
  • Rozerem tablet; consider eszopiclone tablet, zolpidem tablet, zaleplon capsule, ramalteon tablet
  • Tri-Luma cream 
  • Pediaderm HC kit
  • Zemplar capsule; consider paricalcitol capsule
  • Zytiga tablet; consider abiraterone tablet

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 10/17/2019