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

Formulary Additions

  • Afrezza powder cartridge add Tier 3 with medical necessity preauthorization
  • Aristada Initio prefilled syringe add Tier 3 with quantity limit, medical necessity preauthorization
  • Braftovi capsule add Tier 3 with limited access, quantity limit, preauthorization
  • Cuvitru solution add Tier 3 with SP, preauthorization
  • Diclofex DC cream therapy pack add Tier 3 with medical necessity preauthorization
  • Diclosaicin cream Therapy Pack add Tier 3 with medical necessity preauthorization
  • Fulphila prefilled syringe add Tier 3 with SP, preauthorization
  • Ingrezza capsule add Tier 3 with medical necessity preauthorization
  • Mektovi tablet add Tier 3 with limited access, quantity limit, preauthorization
  • Olmesartan-Amlodipine tablet add Tier 1 with quantity limit
  • Olmesartan-HCTZ-Amlodipine tablet add Tier 1 with quantity limit
  • Olmesartan-Hydrochlorothiazide (HCTZ) tablet add Tier 1 with quantity limit
  • Orencia prefilled syringe add Tier 3 with SP, quantity limit, medical necessity preauthorization
  • Yonsa tablet add Tier 3 with limited access, preauthorization

Quantity Limit Update

  • Verapamil ER, Verelan PM, Felodipine ER, Nifedipine ER osmotic release, Nifedical XL, Onglyza remove quantity limit
  • Vancocin, Vancomycin capsule, Donepezil, Aricept, Rivastigmine, Exelon, Symbyax, Flovent HFA, Ranexa, Flovent Diskus, Exforge, Azor, Desvenlafaxine succinate ER, Savella titration pack, Amlodipine-Valsartan-HCTZ, Exforge HCT, Flector, Promacta, Aricept add quantity limit
  • Verelan, Nisoldipine ER, Procardia XL, Pegridy starter pack, Xigduo, Avonex update quantity limit

Step Therapy Update

  • Paxil, Prozac, Wellbutrin, Zoloft, Buproprion, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Venlafaxine, Paxil, Citalopram, Effexor XR, Celexa, Venlafaxine ER, Prozac weekly, Paroxetine ER, Paxil CR, Olmesartan, Lexapro, Escitalopram, Wellbutrin (SR, XL), Buproprion ER (XL, SR), Pexeva, Olanzapine-Fluoxetine, Symbyax, Fluvoxamine ER, Viibryd, Fetzima, Trintellix, add step therapy

Tier Update

  • Benicar HCT, Glipizide XL, Exforge, Azor, Exforge HCT with Tier update

Preauthorization Update

  • Zipsor, Forfivo XL, Methyltestosterone, Striant, Pristiq, Edarbi  add preauthorization

Removed/Excluded from Formulary

  • Teveten HCT tablet

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

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

Formulary Additions

  • Colesevelam tablet add Tier 1
  • Ezetimibe tablet add Tier 1
  • Naglazyme solution add Tier 3 with SP, preauthorization
  • Kalbitor add Tier 3 with SP, preauthorization
  • Hizentra solution add Tier 3 with SP, preauthorization
  • Adapalene 1% lotion add Tier 1
  • Prolia injection add Tier 3 with SP, preauthorization
  • Ala-Cort cream add Tier 1
  • Baclofen tablet add Tier 1
  • Zypitamag tablet add Tier 3 with medical necessity preauthorization
  • Norvir packet add Tier 3
  • Retacrit injection add Tier 2
  • Mili tablet add Tier 0
  • Tri-Mili tablet add Tier 0
  • Arnuity Ellipta 50mcg add Tier 2
  • Lucemyra tablet add Tier 3 with quantity limit, medical necessity preauthorization
  • Doptelet tablet add Tier 3 with quantity over time limit, preauthorization
  • Palynziq prefilled syringe add Tier 3 with preauthorization
  • Olumiant add Tier 3 with quantity limit, medical necessity preauthorization
  • Imvexxy insert add Tier 3 with medical necessity preauthorization
  • Siklos tablet add Tier 3 with medical necessity preauthorization
  • Xeljanz 10mg tablet add Tier 3 with quantity limit, medical necessity preauthorization

Quantity Limit Update

  • Margesic capsule, Alinia solution/tablet, Duloxetine capsule, Aplenzin, Dexilant, Desvenlafaxine ER tablet, Khedezla, Fetzima, Venclexta, Briviact, Jynarque update quantity limit
  • Paroxetine tablets, Escitalopram tablet remove quantity limit
  • Promacta, Cambia packet, Aimovig auto injector add quantity limit

 Tier Update

  • Procrit, Zetia, Alinia solution/tablet, Restasis multidose, Gilenya capsules, Tecfidera capsules with Tier update

 Preauthorization Update

  • Testosterone gel/solution, Axiron solution, Testim gel, Androderm patch update preauthorization to new starts only
  • Olysio, Zolpimist solution add preauthorization
  • Mozobil solution, Restasis multidose remove preauthorization

Removed/Excluded from Formulary

  • Cortane-B, PramOtic, Introl, Cortane-B Aqueous, Otomax-HC, Antipyrine, Oto-End 10, Oticin HC NR, Oticin, Treagan, Otozin, Otic Care, Pinnacaine Otic, MyOxin, Antipyrine-Benzocaine, Folika-V tablets

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

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

October: All States

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

Formulary Additions

  • Amlodipine-Valsartan add Tier 1 with quantity limit
  • Braftovi capsule add Tier 4 with limited access, quantity limit, preauthorization
  • Cuvitru Solution add Tier 4 with SP, preauthorization
  • Mektovi tablet add Tier 4 with limited access, quantity limit, preauthorization
  • Olmesartan-Amlodipine tablet add Tier 1 with quantity limit
  • Olmesartan-HCTZ-Amlodipine tablet add Tier 1 with quantity limit
  • Olmesartan-Hydrochlorothiazide (HCTZ) tablet add Tier 1 with quantity limit
  • Yonsa tablet add Tier 4 with limited access, preauthorization

Quantity Limit Update

  • Verapamil ER, Felodipine ER, Nifedipine ER osmotic release remove quantity limit
  • Nisoldipine ER, Plegridy starter pack update quantity limit
  • Vancomycin capsule, Rivastigmine, Olmesartan, Flovent HFA, Flovent Diskus, Arnuity Ellipta, Savella titration pack, Donepezil add quantity limit

Step Therapy Update

  • Buproprion, Fluvoxamine, Fluoxetine 90mg weekly, Buproprion (XL, SR), Desvenlafaxine ER succinate, Fluvoxamine ER  add step therapy
  • Lisinopril, Benazepril, Captopril-HCTZ, Captopril, Enalapril, Enalapril-HCTZ, Fosinopril, Lisinopril-HCTZ, Quinapril, Ramipril, Perindopril, Amlodipin-Benazepril, Losartan, Losartan-HCTZ, Moexipril, Trandolapril, Irbesartan, Valsartan-HCTZ, Candesartan, Telmisartan, Irbesartan-HCTZ, Eprosartan, Candesartan-HCTZ, Olmesartan, Amlodipine-Benazepril, Tekturna, Candesartan-HCTZ, Edarbi remove step therapy

Preauthorization Update

  • Danazol capsule remove preauthorization
  • Methyltestosterone, Edarbi add preauthorization

Removed from Formulary

  • Mentax cream; consider clotrimazole cream, econazole cream, ketoconazole cream
  • Venlafaxine ER tablets; consider Venlafaxine ER capsules

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

September: All States

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

Formulary Addition

  • Colesevelam tablet add Tier 1
  • Methylphenidate ER (LA) capsule add Tier 1 with quantity limit, preauthorization
  • Kalbitor solution add Tier 4 with SP, preauthorization
  • Cambia packet add Tier 3 with quantity limit, medical necessity preauthorization
  • Restasis Multi-dose vial add Tier 2
  • Baclofen add Tier 1
  • Norvir packet add Tier 3
  • Retacrit add Tier 4 with SP
  • Mili tablet add Tier 0
  • Tri-Mili add Tier 0
  • Arnuity Ellipta add Tier 2
  • Doptelet tablet add Tier 4 with quantity limit, preauthorization
  • Gilenya capsule add Tier 3 with SP, quantity limit, preauthorization
  • Palynziq solution add Tier 4 with quantity limit, preauthorization

Quantity Limit Update

  • Alinia tablet, Duloxetine capsule, Jynarque tablet with updated quantity limit
  • Paroxetine tablet, Citalopram tablet, Escitalopram tablet remove quantity limit
  • Promacta tablet add quantity limit

Step Therapy Update

  • Ala-Cort, Fluocinolone cream/solution, Fluocinonide solution/oil, Triamcinolone ointment, Alclometasone cream/ointment, Amcinonide lotion, Clobetasol Solution/lotion/foam, Mometasone solution, Fluticasone lotion with step therapy update

Preauthorization Update

  • Metoclopramide Dispersible tablet add preauthorization
  • Adapalene gel/cream, Tazorac gel/cream, Clindamycin-Tretinoin gel, Atralin gel, Differin lotion, Mozobil solution remove preauthorization
  • Testosterone gel/solution, Androderm patch update preauthorization to new starts only

Tier Update

  • Alinia tablet/solution with tier update

Removed from Formulary

  • Levorphanol tablets; consider oxycodone, morphine sulfate, tramadol, hydrocodone/acetaminophen
  • Procrit; consider Retacrit
  • Welchol; consider colesevelam 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 9/18/2018