June 2026 Drug List Change Notification (Commercial)
Updates on Existing CriteriaJune 2026. The following changes to criteria are effective by June 22, 2026:Prior Authorization Criteria...
News and updates
May 2026 Community Solutions (Medicaid) formulary and coverage policies notification
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...
Hospital observation services: billing and reimbursement policy updates
Effective July 1, 2026, PacificSource will implement updates to its policies regarding hospital outpatient observation services. Key considerations when billing for these services include the...
Agreement reached with OHSU network
Earlier this year, PacificSource and Oregon Health and Science University (OHSU) entered negotiations for a new agreement. We are pleased to share that those discussions have...
May 2026 Drug List Change Notification (Commercial)
Updates on Existing CriteriaMay 2026. The following changes to criteria are effective by May 22, 2026:Prior Authorization Criteria –...
April 2026 Drug List Change Notification (Commercial)
Updates on Existing CriteriaApril 2026. The following changes to criteria are effective by April 9, 2026:Prior Authorization Criteria...
Pharmacy prior authorization extension notification
As part of our effort to improve access to affordable healthcare, our Pharmacy department is reducing administrative burden by extending the approved date range for certain maintenance...
February 2026 Drug List Change Notification (Commercial)
Updates on Existing CriteriaThe following changes to criteria are effective by February 22, 2026:Prior Authorization Criteria – Clinical Updates...
Prior authorization changes for February 1, 2026 – Medicare and Medicaid
Medicare:Starting February 1, 2026, these services with the listed billing codes will require prior authorization.C9781 - Arthroscopy, shoulder, surgical;...
January 2026 Community Solutions (Medicaid) formulary and coverage policies notification
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...