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August 2025 Drug List Change Notification (Commercial)

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.