Prescription Drug Information and News

Our PacificSource Drug Lists are updated monthly.
Learn more about our PacificSource Drug Lists >  

Our drug lists are available in a searchable online format. Find a Drug >   

Preferred Drug List (PDL) Changes

April 2017. The following changes to the drug list are effective April 22, 2017:

Formulary Additions

  • Humulin R U-500 KwikPen add at Tier 2
  • Adlyxin add at Tier 3 with medical necessity preauthorization
  • Soliqua add at Tier 3 with medical necessity preauthorization
  • Morphine sulfate solution 100 mg/5ml add at Tier 1 with quantity limit of 6 ml per day
  • Tramadol capsule ER add at Tier 1 with medical necessity preauthorization
  • Quetiapine ER add at Tier 1 with quantity limit and step therapy
  • Rubraca add Tier 3, Specialty, with preauthorization and quantity limit
  • Rayaldee add Tier 3 with preauthorization and quantity limit

Remove from Formulary

  • ClindaMax 1% lotion; product discontinued consider clindamycin phosphate 1% lotion
  • Meperitab; product discontinued consider meperidine tablet
  • Hydrocodone-ibuprofen tablet; product discontinued consider hydrocodone-acetaminophen
  • AndroGel Pump; product discontinued consider testosterone cypionate
  • Metozolv ODT; product discontinued consider metoclopramide
  • Ultram ER; product discontinued consider tramadol ER

Tier Change

  • Cefaclor ER from Tier 1 to Tier 2
  • Breo Ellipta, Tradjenta, Jentadueto, Latuda from Tier 3 to Tier 2
  • Migranal, Onglyza, Kombiglyze XR from Tier 2 to Tier 3, add preauthorization
  • Seroquel XR, Primsol solution, Matulane from Tier 2 to Tier 3

Preauthorization Update

  • Zyprexa Relprevv, Dulera, Noritate 1% cream, Aplenzin, Capex, Amoxicillin-Clarithromycin-Lansoprazole, Omeprazole-Sodium Bicarbonate, Luxiq Foam, Metoclopramide dispersible tablet and Duexis add medical necessity preauthorization
  • ConZip and Zubsolv remove step therapy add medical necessity preauthorization
  • Suboxone File remove preauthorization
  • Risperdal Consta add preauthorization

Quantity Limit Update

  • Trulicity, Delzicol, AndroGel, AndroGel Pump, Morphine solution, Meperidine solution, Meperidine tablet, Bupap, Butalbital-Acetaminophen-Caffeine, Vogelxo, Vogelxo Pump, Nalbuphine, Talwin, Butalbital-Acetaminophen-Caffeine-Codeine, Butalbital-Aspirin-Caffeine-Codeine, Butalbital-Acetaminophen-Caffeine, Testosterone Gel, Tradjenta, Butalbital-Acetaminophen, Marten-Tab, Suboxone Film, Lazanda, Apriso and Ultram add quantity limit
  • Ilaris, Asmanex, Olanzapine dispersible tablet, Fentanyl Citrate, Hydromorphone, Hydrocodone-Acetaminophen, Hydrocodone-Ibuprofen, Actiq and Latuda update quantity limit

See the PacificSource Drug Lists page for the current drug list.

March 2017. The following changes to the drug list are effective March 22, 2017:

Formulary Additions 

  • Zepatier add at Tier 2, specialty (SP) with preauthorization and quantity limit
  • Epclusa add at Tier 2, SP with preauthorization and quantity limit
  • Budesonide delayed release capsule add at Tier 1
  • Paliperidone ER add at Tier 1 with quantity limit and step therapy
  • Clindamycin-Tretinoin gel add at Tier 1 with preauthorization
  • Valganciclovir solution add at Tier 1 with quantity limit
  • Invokamet XR add Tier 2
  • Dofetilide add Tier 1, SP
  • Miglitol and Molindone add Tier 1
  • Mesalamine add Tier 1 with medical necessity preauthorization and quantity limit of 6 per day
  • Bicalutamide add Tier 1 with preauthorization and quantity limit
  • Metformin ER (MOD) add Tier 1 with medical necessity preauthorization
  • GoNitro, Yosprala, Ameluz, Vemlidy, Epaned, Qbrelis, Doryx MPC, Invega Trinza, Otovel, Onexton gel and Byvalson add Tier 3 with medical necessity preauthorization

Remove from Formulary 

  • Buproban; product discontinued, consider bupropion SR
  • Enjuvia; product discontinued, consider estradiol tablet, estropipate tablet
  • Abilify Discmelt; product discontinued, consider aripiprazole
  • Reprexain; product discontinued, consider hydrocodone-ibuprofen
  • Brintellix; product discontinued, consider Trintellix

Tier Change 

  • Bactroban, Premarin, Diovan, Viread, Welchol, Elmiron, and Hexalen, from Tier 2 to Tier 3
  • Acamprosate from Tier 2 to Tier 1
  • Pacerone, Vandazole, ClindaMax, Phenadoz, Promethegan, Jantoven, and Gentak ointment from Tier 3 to Tier 1
  • ProAir RespiClick from Tier 3 to Tier 2

Preauthorization Update 

  • Somavert, Lupaneta Pack, Sandostatin, Sandostatin LAR, Veltin, Symlin, Octreotide, Leuprolide, Somatuline Depot, Trelstar, Thalomid, Eligard, and Ziana add preauthorization
  • Apidra, Thiola, Vasotec, Qudexy XR, Aripiprazole dispersible tablet, Trokendi XR, Viekira Pak, and Sovaldi add medical necessity preauthorization
  • Anadrol-50 remove preauthorization

Step Therapy Update 

  • Fanapt, Invega, Quetiapine XR, Saphris, and Invega Sustenna add Step Therapy

Quantity Limit Update 

  • Symbyax, Zyprexa Zydis, Valcyte, Januvia, Remeron SolTab, Olanzapine-Fluoxetine, Aripiprazole, Farxiga, Trintellix, and Xarelto update quantity limit  
  • Dipentum, Balsalazide, Budesonide suspension, Victoza, Beconase AQ, Veramyst, Pulmicort, Byetta, Omnaris, Zetonna, Colazal, Vraylar, Pomalyst, Qvar, Qnasl, Canasa, Pentasa, Lialda, Mometasone suspension, Metformin ER (OSM), Saphris, Jentadueto, and Asmanex add quantity limit
  • Remeron, irbesartan, Pioglitazone, mirtazapine, glimepiride, Bupropion ER (XL), and lisinopril remove quantity limit

Incentive List Update 

  • Remove Fluoxetine 60 mg tablet: consider fluoxetine 20 mg, fluoxetine 40 mg, citalopram, paroxetine, sertraline

See the PacificSource Drug Lists page for the current drug list.

State-based Drug List (ID, MT, OR) Changes

April 2017. The following changes to the drug list are effective April 22, 2017:  

Formulary Additions

  • Bacitracin reconstituted solution add Tier 1
  • Ceftin oral suspension add Tier 3
  • Clindamycin 75 mg capsule add Tier 1
  • Colistimethate injection add Tier 1
  • Pentazocine-Naloxone tablet add Tier 1 with quantity limit
  • Rayaldee add Tier 3 with preauthorization and quantity limit

Removed from Formulary

  • Butorphanol Solution; consider morphine, oxycodone, tramadol
  • Onglyza; consider Januvia
  • Primsol solution; consider trimethoprim tablet
  • Suprax; consider cefixime suspension
  • Clindamycin 1% foam; consider clindamycin gel/lotion
  • Cefixime tablet; consider cefixime 125 mg/5ml suspension
  • Pure Tek Lidocaine patch; consider generic Lidocaine from other makers

Tier Change

  • Ceftin suspension, Suprax, Viread from Tier 2 to Tier 3
  • Tradjenta from Tier 3 to Tier 2

Preauthorization Update

  • Tradjenta, Suboxone Film remove preauthorization

Quantity Limit update

  • Meperidine, Asmanex, Butalbital-Acetaminophen-Caffeine, oxycodone, hydromorphone, Butalbital-Aspirin-Caffeine, Hydrocodone-Acetaminophen, Butalbital-Acetaminophen-Caffeine, Suboxone Film and Lazanda update quantity limit
  • Ilaris, Rosuvastatin, Butalbital Acetaminophen-Caffeine-Codeine, Butalbital-Aspirin-Caffeine-Codeine, Butalbital-Acetaminophen-Caffeine, Codeine, testosterone gel and Apriso add quantity limit

See the PacificSource Drug Lists page for the current drug list

March 2017. The following changes to the drug list are effective March 22, 2017:

Formulary Additions 

  • Trulicity add Tier 3 with preauthorization and quantity limit
  • Zepatier add Tier 4 with preauthorization and quantity limit
  • Epclusa add Tier 4 with preauthorization and quantity limit
  • Linezolid oral suspension, Miglitol, and Molindone add Tier 1
  • Paliperidone ER add Tier 1 with Step Therapy and quantity limit
  • Clindamycin-Tretinoin gel add Tier 1 with preauthorization
  • Dofetilide add Tier 4
  • ProAir RespiClick add Tier 2
  • Nilutamide add Tier 1 with preauthorization and quantity limit
  • Valchlor gel add Tier 4 with preauthorization
  • Sivextro add Tier 3 with quantity limit

Removed from Formulary 

  • Zyvox suspension; consider linezolid oral suspension
  • Tikosyn; consider dofetilide
  • Viekira Pak; consider Zepatier, Epclusa
  • Sovaldi; consider Zepatier, Epclusa
  • Quinidine sulfate ER; product discontinued, consider quinidine gluconate ER
  • Seroquel XR; consider quetiapine XR
  • Aplenzin; consider bupropion, bupropion ER
  • Benzoyl Peroxide Wash, BP gel; consider benziq gel
  • Invega; consider paliperidone ER

Tier Change 

  • Cholbam, Zydelig, Sucraid from Tier 3 to Tier 4
  • Matulane and Photofrin from Tier 2 to Tier 4
  • Nilandron, Risperdal Consta, Hexalen, Xifaxan from Tier 2 to Tier 3
  • Streptomycin from Tier 1 to Tier 3
  • Adefovir from Tier 4 to Tier 1

Preauthorization Update 

  • Apidra add medical necessity preauthorization

Quantity Limit Update 

  • Januvia, olanzapine dispersible tablet, aripiprazole, Farxiga, and Xarelto update quantity limit
  • Dipentum, balsalazide, Victoza, Saphris, Tradjenta, Jentadueto, Jardiance, Invokana, Pentasa, Lialda, Canasa, Rexulti, Pomalyst, Vraylar, and Latuda add quantity limit

Incentive List Update 

  • Remove Fluoxetine 60 mg tablet; consider fluoxetine 20 mg, fluoxetine 40 mg, citalopram, paroxetine, sertraline

See the PacificSource Drug Lists page for the current drug list.

“Partial Fill” Lets a Patient Test a New Prescription

As you know, some drugs not only have a high cost, but have side effects that make them hard to tolerate for long-term use. Beginning February 22, 2016, these medications will be dispensed in a limited amount, on the first fill only, for half the normal copay. This “partial fill” will act as a trial period to see if the patient is able to successfully take the drug. 

A week into the first fill, a Caremark Specialty Care Team pharmacist or nurse will contact the patient. They will check on side effects and see if the patient was able to tolerate the drug. The Care Team will also answer questions and concerns about the treatment. If the trial period is a success, the patient will continue the drug. After this initial trial, all future fills will be for the full amount. 

On our drug lists, partial-fill drugs are identified by “Partial Fill” in the Restrictions column.

Partial-fill drugs include:

  • Afinitor
  • Bosulif
  • Erivedge
  • Gleevec
  • Inlyta
  • Jakafi
  • Nexavar
  • Odomzo
  • Sprycel
  • Sutent
  • Tafinlar
  • Tarceva
  • Targretin
  • Tasigna
  • Votrient
  • Xalkori
  • Xtandi
  • Zolinza
  • Zykadia
  • Zytiga

Preauthorization and Step Therapy Drug Lists with Criteria

Our Preauthorization Policies and Step Therapy Policies documents contain lists of drugs that require preauthorization or that are Step Therapy drugs, as well as their criteria. These two documents replace the one-page "PDL/VDL Preauthorization and Step Therapy Drug Lists" document. You may also use Preauthorization Policies to access our coverage rules for compound medications.

Flu and Pertussis Vaccination Coverage

Our flu vaccination page now includes information about your coverage for whooping cough (pertussis), as well as seasonal flu vaccination and general information.

Consumer Updates from the FDA

Quick Links

PacificSource Drug Lists—our comprehensive drug list page

Preventive Drug List

Incentive Drug List

Prescription drug claim form

Prescription Drug Preauthorization Request (Fax)

InTouch for Members

Are you a Medicare or Medicaid member?

If so, we have a website just for you!

Cool Tools for Managing Your Rx

On the CVS Caremark® website, you'll find tools to help you track pharmacy expenses, save on drug costs, manage your prescriptions, and more. Register by using the member ID number and group code on your ID card. To start, visit Caremark.com.

Why Choose Generics?

Generic prescription medicines are safe, effective, and a good value. Save money by using them instead of brand name drugs whenever possible.

Questions?

Contact our Pharmacy Services Department:

  • Phone: (541) 225-3784
  • Toll-free: (800) 624-6052, ext. 3784
  • Email: Use our online Contact Us form
Last updated 3/23/2017