We would like to inform you of changes to our PacificSource Community Solutions formulary and coverage policies.
We have recently updated our prior authorization list and coverage policies. These changes are effective for dates of service on or after July 15, 2026.
Summary of changes effective July 15, 2026
Change: Removed from formulary
- Pomalyst
- Dificid
- Invokana
- Invokamet
- Invokamet XR
- Steglatro
- Segluromet
- Jardiance
- Prolia
- Xgeva
In addition to the above changes, we have updated the formulary to include a number of new medications that have been released in the past year. For a complete formulary listing, visit our Find a drug: Medicaid page.
If you have questions regarding these changes, please contact your PacificSource Provider Relations Representative or the PacificSource Pharmacy Services Team at 888-437-7728 or 541-330-4999.