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

December 2018. The following changes to the drug list are effective December 22, 2018:

Formulary Additions

  • Carbinoxamine 6mg tablet add Tier 1 medical necessity preauthorization
  • Chlorzoxazone 250mg tablet add Tier 1 with medical necessity preauthorization
  • Clindamycin-Benzoyl Peroxide gel 1.2-2.5% gel add Tier 1 with medical necessity preauthorization
  • Dapsone gel add Tier 1 with medical necessity preauthorization
  • Delstrigo tablet add Tier 2 with quantity limit
  • DermacinRx Lexitral cream pack add Tier 3 with medical necessity preauthorization
  • Diclofex DC add Tier 1 with medical necessity preauthorization
  • Diclopak add Tier 1 with medical necessity preauthorization
  • Diclotral pack add Tier 1 with medical necessity preauthorization
  • Edex kit add Tier 3 with preauthorization
  • Ilumya solution add Tier 3 with SP and medical necessity preauthorization
  • Keragel add Tier 3 with medical necessity preauthorization
  • KeragelT add Tier 3 with medical necessity preauthorization
  • Lenvima capsule add Tier 3 with limited access, quantity limit and preauthorization
  • Mulpleta tablet add Tier 3 with SP, quantity limit and preauthorization
  • Muse Pellet add Tier 3 with preauthorization
  • NuDiclo SoluPak add Tier 1 with medical necessity preauthorization
  • Orkambi packet add Tier 3 with quantity limit, limited access, partial fill and preauthorization
  • Perseris syringe add Tier 3 with preauthorization
  • Pifeltro tablet add Tier 3 with quantity limit
  • Plenvu solution add Tier 0 with ACA restrictions may apply
  • Qbrexza pad add Tier 3 with medical necessity preauthorization
  • Sure Result DSS Premium pack add Tier 1 with medical necessity preauthorization
  • Vexasyn gel add Tier 3 with medical necessity preauthorization
  • Xelitral pack add Tier 1 with medical necessity preauthorization

Quantity Limit Update

  • Tekturna, Tekturna HCT,  add quantity limit

Step Therapy Update

  • Buprenorphine Patch, Butrans, Azelex cream, Acanya gel remove step therapy
  • Januvia, Janumet, Tradjenta, Jentadueto, Janumet XR, Farxiga, Jardiance, Xigduo XR, Glyxambi, Synjardy, Synjardy XR, Jentadueto XR add step therapy

Preauthorization Update

  • Acanya gel, Azelex cream add medical necessity preauthorization

Removed/Excluded from Formulary

  • Marcaine Spinal solution, Sensorcaine-MPF spinal solution, Procaine crystals, Nortuss-EX, Tusnel capsule, Decon-G, NeoTuss-D, Giltuss Ped-C, Bupivacaine Spinal, Phenylephrine-Chorpheniramine DM, Biotuss, Giltuss TR, Biotuss Pediatric, Phenylephrine-Guaifenesin, Carbaphen 12, Carbaphen 12 Ped, Relhist

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

November 2018. The following changes to the drug list are effective November 22, 2018:

Formulary Additions

  • Tadalafil tablet add Tier 1 with quantity limit and preauthorization
  • Vesicare tablet add Tier 2 with step therapy
  • Rasagiline tablet add Tier 1 with quantity limit
  • Toviaz tablet add Tier 3 with step therapy
  • Vancomycin IV solution add Tier 1
  • Vibativ IV solution add Tier 3
  • Tropazone lotion add Tier 3
  • Neosalus lotion add Tier 3
  • Myrbetriq tablet add Tier 2 with step therapy
  • Utibron Neohaler add Tier 3 with quantity limit and medical necessity preauthorization
  • BromSite ophthalmic solution add Tier 3
  • Gelnique Pump add Tier 3 with step therapy
  • Eskata solution add Tier 3 with quantity limit and medical necessity preauthorization
  • Firvanq oral solution add Tier 2
  • Cimduo tablet add Tier 2
  • Lucemyra tablet add Tier 3 with SP, quantity limit and medical necessity preauthorization
  • Symtuza tablet add Tier 3
  • Kapspargo Sprinkle capsule add Tier 3
  • Macrilen packet add Tier 3 with preauthorization
  • Nuplazid tablet and capsule add Tier 3 with quantity limit and preauthorization
  • Tibsovo tablet add Tier 3 with quantity limit and preauthorization
  • Orilissa tablet add Tier 3 with quantity limit and preauthorization
  • Lokelma packet add Tier 3 with medical necessity preauthorization
  • Imvexxy insert add Tier 3 with medical necessity preauthorization

Quantity Limit Update

  • Levofloxacin 250mg tablet remove quantity limit
  • Tracleer tablet, Advair HFA, Advair Diskus, Symbicort, Breo Ellipta, Opsumit tablet, Xerese cream, Anoro Ellipta, Stiolto Respimat, Bevespi Aerosphere, Lynparza tablet, Tracleer, Ozempic solution  add quantity limit
  • Requip XL tablet update quantity limit

Step Therapy Update

  • Ozempic solution add step therapy

Tier Update

  • Epogen, Lupron Depot, Procrit, Zoladex implant, Avonex, Tarceva tablet, Trelstar, Sprycel tablet, Letairis tablet, Bystolic tablet, Trelstar Mixject, Toviaz tablet, Extavia, Stiolto Respimat

Preauthorization Update

  • Enablex tablet, Coreg CR capsule, Extavia, Xerese cream, Tracleer add medical necessity preauthorization
  • Ozempic solution remove preauthorization

Removed/Excluded from Formulary

  • Chlordiazepoxide-Clidinium capsule
  • Levocetirizine tablet and oral solution

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

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

December: All States

December 2018. The following changes to the drug list are effective December 22, 2018:

Formulary Addition

  • Betaseron solution add Tier 4 with SP, quantity limit and preauthorization
  • Clindamycin-Benzoyl Peroxide gel 1.2-2.5% gel add Tier 1 with medical necessity preauthorization
  • Dapsone 5% gel add Tier 1 with medical necessity preauthorization
  • Delstrigo tablet add Tier 2 with quantity limit
  • Hemlibra solution add Tier 4 with SP and preauthorization
  • Lenvima capsule add Tier 4 with limited access, quantity limit and preauthorization
  • Mulpleta tablet add Tier 4 with SP, quantity limit and preauthorization
  • Orkambi packet add Tier 4 with limited access, partial fill, quantity limit and preauthorization
  • Perseris syringe add Tier 3 with preauthorization
  • Pifeltro tablet add Tier 3 with quantity limit
  • Plenvu solution add Tier 0 with ACA restrictions

Quantity Limit Update

  • Tekturna, Tekturna HCT add quantity limit

Step Therapy Update

  • Azelex, Buprenorphine weekly patch remove step therapy
  • Januvia, Janumet, Tradjenta, Jentadueto, Jentadueto XR, Janumet XR, Farxiga, Jardiance, Xigduo XR, Glyxambi, Synjardy, Synjardy XR add step therapy

Preauthorization Update

  • Azelex add medical necessity preauthorization
  • Tazarotene cream 1% remove preauthorization

Removed from Formulary

  • Acanya gel; consider Clindamycin-Benzoyl Peroxide gel 1-5%, Clindamycin-Benzoyl Peroxide gel 1-2.5% 
  • Adcirca; consider tadalafil tablet, sildenafil tablet
  • Z-Tuss AC, Codar AR, Virtussin A/C

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

November: All States

November 2018. The following changes to the drug list are effective November 22, 2018:

Formulary Addition

  • Tadalafil tablet add Tier 1 with quantity limit and preauthorization
  • Midazolam solution add Tier 1
  • Avonex add Tier 4 with SP, quantity limit and preauthorization
  • Aubagio tablet add Tier 4 with SP, quantity limit and preauthorization
  • Opsumit add Tier 4 with SP, quantity limit and preauthorization
  • Stiolto Respimat add Tier 2 with quantity limit
  • Lynparza tablet add Tier 4 with SP, limited access, partial fill, quantity limit and preauthorization
  • Ozempic solution add Tier 2 with step therapy, quantity limit and preauthorization
  • Cimduo tablet add Tier 2
  • Macrilen packet add Tier 4 with SP and preauthorization
  • Nuplazid tablet/capsule add Tier 4 with SP, quantity limit and preauthorization
  • Tibsovo tablet add Tier 4 with SP, quantity limit and preauthorization
  • Orilissa tablet add Tier 3 with quantity limit and preauthorization

Quantity Limit Update

  • Levofloxacin 250mg tablet remove quantity limit
  • Rasagiline tablet, Advair HFA, Advair Diskus, Symbicort, Letairis tablet, Rebif solution add quantity limit

Tier Update

  • Vesicare tablet, Bystolic tablet, Toviaz tablet, Myrbetriq tablet, Breo Ellipt

Removed from Formulary

  • Tracleer tablets; consider Opsumit, Letairis
  • Extavia; consider Avonex, Betaseron, Plegridy, Rebif
  • Chlordiazepoxide-Clidinium capsule, Levocetirizine solution/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 11/15/2018