Updates on Existing Criteria
June 2025. The following changes to criteria are effective June 22nd, 2025:
Prior Authorization Criteria – Clinical Updates
- Targeted Immune Modulators – add Selarsdi and Yesintek to the Preferred Drugs and Preferred Medical Drugs lists
Preferred Drug List (PDL) Changes
June 2025. The following changes to the drug list are effective June 22, 2025:
Prior Authorization
- Remove Medical Necessity
- Selarsdi injection
- Yesintek injection
State Based Drug List (OR, ID, MT, WA) Changes
June 2025. The following changes to the drug list are effective June 22, 2025:
Formulary Additions
- Selarsdi injection add tier 4 with SP and prior authorization
- Yesintek injection add tier 4 with SP and prior authorization
See the PacificSource Drug Lists page for the current drug list.