Updates on Existing Criteria
August 2025. The following changes to criteria are effective August 1st, 2025:
Prior Authorization Criteria – Clinical Updates
- Targeted Immune Modulators – remove Stelara from Preferred Drugs and Preferred Medical Drugs list. Add Stelara to Non-preferred Medical Drugs list
Preferred Drug List (PDL) Changes
August 2025. The following changes to the drug list are effective August 1st, 2025:
Prior Authorization
- Add Medical Necessity
- Stelara injection
State Based Drug List (OR, ID, MT, WA) Changes
August 2025. The following changes to the drug list are effective August 1st, 2025:
Removed from Formulary
- Stelara injection
See the PacificSource Drug Lists page for the current drug list.