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 October 15, 2022.
Please review the summary of these changes below:
|
Drug Name |
Change |
Effective Date |
|---|---|---|
|
Ruzurgi
|
Remove from Formulary
|
10/15/2022 |
|
Apokyn |
Remove Brand from Formulary
|
10/15/2022 |
|
Daraprim |
Remove Brand from Formulary
|
10/15/2022 |
|
Pyrimethamine tablets |
Add Prior Authorization |
10/15/2022 |
|
Nuedexta |
Remove from Formulary |
10/15/2022 |
|
Upneeq solution |
Remove from Formulary |
10/15/2022 |
|
Vascepa 1gm capsule |
Remove Brand from Formulary |
10/15/2022 |
|
Vimpat tablet and solution |
Remove Brand from Formulary |
10/15/2022 |
In addition to the above changes, we have updated the formulary to include a number of new medications that have been released in the last year. For a complete formulary listing, please visit our website at CommunitySolutions.PacificSource.com/Tools/DrugSearch.
If you have questions regarding these changes, please contact your PacificSource Provider Service Representative or the PacificSource Pharmacy Services Department at (888) 437-7728 or (541) 330-4999.
Sincerely,
Provider Network