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For certain medical procedures, supplies, and drugs, PacificSource requires approval in advance—a process called prior authorization or preauthorization. This is to determine whether the procedure or medicine is covered under your plan. 

Your provider can request prior authorization from our Health Services Department by fax, mail, or email. If the provider won’t request prior authorization for you, you may contact us directly and we’ll assist with the process. In some cases, we may ask for more information or a second opinion before authorizing coverage. 

Prior authorization resources

Prescription Drugs

Our Find a Drug page includes information on prescription drugs requiring prior authorization.  

View our Prior Authorization Criteria 

View our Step Therapy Criteria

Diabetic Supply List 

Medical procedures and supplies

With our Provider Authorization Grid, you can search for a procedure or medical supply to learn whether prior authorization is required.

Search Authorization Grid

Important notes

  • A prior authorization does not mean that the entire cost of the service will be covered. Your plan’s deductible, coinsurance, and copays still apply. (You can learn more about these terms in our Glossary).
  • "Experimental or investigational" procedures and surgeries are not covered.
  • If your treatment is not preauthorized, you can still seek treatment, but you will be responsible for the expense if it is not medically necessary, or is not covered by your plan. 

If you’re unsure whether an expense will be covered, or for any questions about your benefits, we encourage you to contact our Customer Service team