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

October 2019. The following changes to the drug list are effective October 22, 2019:

Formulary Additions

  • Adhansia XR capsule add Tier 3 with quantity limit and preauthorization
  • Ammonium lactate cream 12% add Tier 1
  • Ammonium lactate lotion 12% add Tier 1
  • Annovera ring add Tier 0 (ACA drug, limits apply)
  • Ciclodan solution kit 8% add Tier 3
  • Dotti patch add Tier 1
  • Doxylamine-pyridoxine delayed release tablet add Tier 1
  • Egaten tablet add Tier 3 with quantity limit over time and medical necessity preauthorization
  • Emgality 300mg syringe add Tier 3 with quantity limit and preauthorization
  • Erythromycin delayed release tablet add Tier 1
  • Ezallor sprinkle capsule add Tier 3 with quantity limit
  • Fentanyl citrate buccal tablet add Tier 1, with quantity limit and preauthorization
  • Inflatherm kit add Tier 3 with medical necessity preauthorization
  • LMR plus kit add Tier 3 with medical necessity preauthorization
  • Methoxsalen capsule add Tier 1
  • Oxandrolone tablet add Tier 1
  • Pyridostigmine tablet add Tier 3
  • Quinosone kit add Tier 3 with medical necessity preauthorization
  • Ramelteon tablet add Tier 1 with quantity limit and step therapy
  • Retin-A Micro Pump 0.06% add Tier 3 with medical necessity preauthorization
  • Retin-A Micro Pump 0.08% add Tier 3 with medical necessity preauthorization
  • Sildenafil suspension add Tier 1 with SP and preauthorization
  • Slynd tablet add Tier 0 (ACA drug, limits apply)
  • Sunosi tablet add Tier 3 with quantity limit and preauthorization
  • Symdeko therapy pack add Tier 3 with SP, quantity limit and preauthorization
  • Thiola EC tablet add Tier 3 with medical necessity preauthorization
  • Varophen kit add Tier 3 with medical necessity preauthorization
  • Ximino extended release capsule add Tier 3 with medical necessity preauthorization
  • Xpovio therapy pack add Tier 3 with SP, quantity limit and medical necessity preauthorization

Quantity Limit Update

  • Update quantity limit:
    • Adderall 20mg tablet
    • Amphetamine-Dextroamphetamine 20mg tablet
    • Tetrabenazine tablet

Preauthorization Updates

  • Add preauthorization:
    • Demser capsule (medical necessity)
    • Fabior Foam (medical necessity)
    • Sorilux foam (medical necessity)
    • Temodar capsule
    • Temozolomide capsule
    • Zytiga tablet (medical necessity)
  • Remove preauthorization:
    • Acitretin capsule
    • Ketoconazole foam
    • Soriatane capsule
    • Ultravate lotion

Tier Update

  • Avita cream
  • Avita gel
  • Benziq Wash liquid
  • Calcitrene ointment
  • Ciclodan cream
  • Ciclodan solution
  • DexPak
  • Differin lotion
  • Nystop powder
  • Physicians EZ Use M-Pred kit
  • Retin-A micro gel
  • Rosadan cream
  • Rosadan gel
  • TaperDex pack
  • Thermazene cream
  • Tretinoin microsphere gel
  • Triderm Cream
  • Zaclir cleansing lotion

Removed from Formulary

  • 8-Mop capsule
  • Amturnide tablet
  • Aristospan intralesional suspension
  • Clindamax gel
  • CNL8 nail kit
  • Cutivate cream
  • Flo-Pred suspension
  • HyGel
  • Isoptin SR tablet
  • LoKara lotion
  • Melquin 3% solution
  • Pediaderm AF complete kit
  • Pediaderm HC kit
  • Pediaderm TA kit
  • Sulfoam shampoo
  • Tri-Luma cream
  • Xenaderm ointment

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

October 2019. The following changes to the drug list are effective October 1, 2019:

Removed from Formulary:

  • CAVAREST GEL 1.1 %
  • CAVIRINSE SOLUTION 0.2 %
  • CLINPRO 5000 PASTE 1.1 %
  • CONTROLRX CREAM 1.1 %
  • DENTA 5000 PLUS CREAM 1.1 %
  • DENTAGEL GEL 1.1 %
  • FLUORIDEX DAILY DEFENSE GEL 1.1 %
  • FLUORIDEX ENHANCED WHITENING GEL 1.1 %
  • FLUORIDEX SENSITIVITY RELIEF PASTE 1.1-5 %
  • GEL-KAM ORAL CARE RINSE CONCENTRATE 0.63 %
  • NAFRINSE DAILY/NEUTRAL SOLUTION RECONSTITUTED 0.05 %
  • NEUTRAGARD ADVANCED GEL 1.1 %
  • PHOS-FLUR GEL 1.1 %
  • PREVIDENT 5000 BOOSTER PASTE 1.1 %
  • PREVIDENT 5000 BOOSTER PLUS PASTE 1.1 %
  • PREVIDENT 5000 DRY MOUTH GEL 1.1 %
  • PREVIDENT 5000 ENAMEL PROTECT PASTE 1.1-5 %
  • PREVIDENT 5000 PLUS CREAM 1.1 %
  • PREVIDENT 5000 SENSITIVE PASTE 1.1-5 %
  • PREVIDENT GEL 1.1 %
  • PREVIDENT SOLUTION 0.2 %
  • sf 5000 plus cream 1.1 %
  • sf gel 1.1 %

See the PacificSource Drug Lists page for the current drug list

September 2019. The following changes to the drug list are effective September 22, 2019:

Formulary Additions

  • Adapalene 0.1% pads add Tier 1 with medical necessity preauthorization
  • Beser Kit add Tier 3 with medical necessity preauthorization
  • Beser lotion add Tier 1 with medical necessity preauthorization
  • Bosentan tablet add Tier 1 with SP, quantity limit and preauthorization
  • Cinacalcet tablet add Tier 1 with SP and preauthorization
  • Cutaquig solution add Tier 3 with SP and preauthorization
  • Erlotinib tablet add Tier 1 with SP, quantity limit, partial fill and preauthorization
  • Fragmin solution add Tier 3
  • Ingrezza capsule add Tier 3 with medical necessity preauthorization
  • Insulin Lispro solution add Tier 1 with medical necessity preauthorization
  • Loteprednol ophthalmic suspension add Tier 1
  • Mesalamine capsule add Tier 1 with quantity limit and medical necessity preauthorization
  • Nucala solution/auto injector add Tier 3 with SP, quantity limit and preauthorization
  • Penicillamine capsule add Tier 1
  • Piqray dose pack add Tier 3 with SP and preauthorization
  • Pregabalin capsule/oral suspension add Tier 1 with quantity limit and step therapy
  • Qtern tablet add Tier 3 with medical necessity preauthorization
  • Ruzurgi tablet add Tier 3 with SP and preauthorization
  • Tuxarin ER tablet add Tier 3 with quantity limit
  • Zelnorm tablet add Tier 3 with medical necessity preauthorization
  • Zenevix pack add Tier 3 with medical necessity preauthorization
  • Zykadia tablet add Tier 3 with SP, partial fill, quantity limit and preauthorization

Step Therapy Update

  • Metaxalone tablet – add step therapy

Quantity Limit Update

  • Add quantity limit:
    • Edacrin tablet
    • Ethacrynic Acid tablet
    • Metaxalone tablet
    • Tyvaso solution (including Starter and Refill kits)
  • Update quantity limit:
    • Hydrocodone/Acetaminophen 7.5/325mg tablet
    • Zykadia Capsule

Preauthorization Updates

  • Add preauthorization:
    • Sensipar tablet
  • Remove preauthorization:
    • Metaxalone tablet

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

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

October: All States

October 2019. The following changes to the drug list are effective October 22, 2019:

Formulary Addition

  • Acyclovir cream add Tier 1 with quantity limit and step therapy
  • Acyclovir ointment add Tier 1 with step therapy
  • Annovera vaginal ring add Tier 0 (ACA drug, limits apply)
  • Dotti patch add Tier 1
  • Emgality 300mg syringe add Tier 3 with quantity limit and preauthorization
  • Fentanyl citrate buccal tablet add Tier 1 with quantity limit and preauthorization
  • Ramelteon tablet add Tier 1 with quantity limit and step therapy
  • Slynd tablet add Tier 0 (ACA drug, limits apply)
  • Stimate solution add Tier 4 with preauthorization
  • Sunosi tablet add Tier 3 with quantity limit and preauthorization
  • Symdeko therapy pack add Tier 4 with SP, quantity limit and preauthorization
  • Testosterone gel 1.62% add Tier 1 with quantity limit and preauthorization
  • Viibryd starter pack add Tier 3 with quantity limit and step therapy

Quantity Limit Update

  • Add quantity limit:
    • Viibryd tablet
  • Update quantity limit:
    • Amphetamine-dextroamphetamine 20mg tablet
    • Jynarque therapy pack
    • Tetrabenazine tablet

Step Therapy Update

  • Mirvaso gel – Add step therapy

Preauthorization Update

  • Add preauthorization:
    • Fluorouracil 0.5% cream (medical necessity)
    • Veregen ointment
  • Remove preauthorization:
    • Acitretin capsule
    • Mirvaso gel

Tier Update

  • Nitroglycerin solution

Removed from Formulary

  • 8-Mop capsule; consider methoxsalen capsule
  • Denavir cream; consider oral acyclovir capsule or tablet, valacyclovir tablet, famciclovir tablet, acyclovir ointment, acyclovir cream
  • Fentora tablet; consider oxycodone tablet, morphine sulfate tablet, hydromorphone tablet, fentanyl citrate buccal tablet
  • Hydrocortisone suppository; consider proctocare-HC cream, hydrocortisone cream, proctosol HC cream
  • Rozerem tablet; consider eszopiclone tablet, zolpidem tablet, zaleplon capsule, ramalteon tablet
  • Tri-Luma cream 
  • Pediaderm HC kit
  • Zemplar capsule; consider paricalcitol capsule
  • Zytiga tablet; consider abiraterone tablet

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

September: All States

September 2019. The following changes to the drug list are effective September 22, 2019:

Formulary Addition

  • Cinacalcet tablet add Tier 4 with SP and preauthorization
  • Copaxone prefilled syringe add Tier 4 with SP, quantity limit and preauthorization
  • Cutaquig solution add Tier 4 with SP and preauthorization
  • Erlotinib tablet add Tier 4 with SP, quantity limit, partial fill and preauthorization
  • Framin add Tier 3 with SP, quantity limit and preauthorization
  • Gattex kit add Tier 4 with preauthorization
  • Loteprenol ophthalmic solution add Tier 1
  • Nucala solution add Tier 4 with SP, quantity limit and preauthorization
  • Piqray dose pack add Tier 4 with SP and preauthorization
  • Pregabalin capsule/oral suspension Tier 1 with step therapy
  • Ruzurgi tablet add Tier 4 with SP and preauthorization
  • Tyvaso solution add Tier 4 with SP, quantity limit and preauthorization
  • Zykadia tablet add Tier 4 with SP, partial fill, quantity limit and preauthorization

Quantity Limit Update

  • Add quantity limit:
    • Ethacrynic Acid tablet
    • Livalo Tablet
    • Metaxalone tablet
    • Paliperidone extended release tablet
    • Saphris tablet
    • Tyvaso starter kit
  • Update quantity limit:
    • Zykadia capsule

Step Therapy Update

  • Metaxalone tablet – Add step therapy

Preauthorization Update

  • Remove preauthorization:
    • Metaxalone tablet

Tier Update – for members older than 6 years of age

  • Fluorabon
  • Fluoritab
  • Ludent chewable tablet
  • Sodium Fluoride chewable tablet
  • Sodium Fluoride solution

Removed from Formulary

  • Lotemax suspension; consider loteprednol ophthalmic suspension
  • Lyrica capsule and oral suspension; consider pregabalin capsule and oral suspension
  • Sensipar tablet; consider cinacalcet tablet
  • Tarceva tablet; consider erlotinib tablet

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

Non-FDA Approved Compounding Agents

A compounded medication is when a pharmacist combines multiple ingredients together. Compounded claims often use what we called "bulk powders." These powders act as a mixing agent/congealing agent to hold the finished product together. These ingredients may not always be approved by the Food and Drug Administration (FDA), thus may not have been reviewed for safety and efficacy. To ensure you are taking medications proven to be safe and effective, beginning August 1, 2017, the non-FDA approved ingredients will be removed from coverage on your plan.

Examples of common non-FDA approved agents:

  • Cellulose (bulk) powder
  • Alcohol, usp 95%
  • Cream base
  • Fatty acid base
  • Gelatin capsules (empty)
  • Hypromellose (bulk) powder
  • Hormone cream base
  • Propylene glycol liquid
  • Thyroid powder
  • Silica gel
  • Stevia (bulk) powder
  • Vitamin E acetate (bulk) liquid

See the non-FDA approved bulk powder agents for the full 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: (844) 877-4803
  • Email: Use our online Contact Us form
Last updated 9/20/2019