March 2024 Drug List Change Notification (Commercial)
Updates on Existing Criteria
March 2024. The following changes to criteria are effective March 22, 2024:
Prior Authorization Criteria – Clinical Updates...
News and updates
Paxlovid™ is available to most PacificSource members at no cost, or at a discount
We're pleased to inform you that PacificSource members are eligible to enroll in the PAXCESS™ Patient Support Program through Pfizer. A current prescription...
Pharmacy coverage updates effective February 15, 2024 (Medicaid)
We have recently updated our prior authorization list and coverage policies for Medicaid patients. This change is effective for dates of service on or after February 15, 2024....
February 2024 Drug List Change Notification (Commercial)
Updates on Existing Criteria
February 2024. The following changes to criteria are effective February 22, 2024:Prior Authorization...
New process for claim-status checks
All claim-status checks must be completed using our secure provider portal, InTouch for Providers (OneHealthPort). We will no longer accept Claim Status Request forms submitted via...
Alternative care contracting changes for some Oregon and Washington providers
Effective March 1, 2024, alternative care providers contracted through The CHP Group will no longer be considered in-network. Instead, PacificSource will begin contracting directly with alternative...
Change to therapeutic continuous glucose monitor benefit
Currently, continuous glucose monitors are covered under both durable medical equipment (DME) and pharmacy benefits. Effective January 1, 2024, we are transitioning all therapeutic CGMs to the...
January 2024 Drug List Change Notification (Commercial)
Updates on Existing Criteria
January 2024. The following changes to criteria are effective January 22, 2024:
Prior Authorization Criteria – Clinical...
Prior authorization requirement changes effective January 1, 2024 (Medicaid)
Certain codes will require prior authorization for Oregon Medicaid members.
Behavioral health criteria changing November 13, 2023
Beginning November 13, 2023, PacificSource will use different criteria for level-of-care decisions for mental health treatment (including inpatient, residential, partial...