Plan drug lists
Search or download our formularies for specific drugs or drug types.
No-cost and incentive drug lists for commercial members
Affordable Care Act Standard Preventive No-cost Drug List (CVS Caremark)
The ACA Standard Preventive No-cost Drug List contains medications required by the government to be available at no cost to members of a health insurance plan. The list is maintained by CVS Caremark.
PacificSource Expanded Preventive No-cost Drug List
The Expanded No-cost Drug List is included in our individual and small-group plans, and is an optional benefit for large groups. With this benefit, the drugs listed below are paid at 100 percent. This list is a separate benefit from preventive service drugs covered under the Affordable Care Act.
Value Based Preventive No-cost Drug List
The Value Based Preventive No-cost Drug List is offered to select self-funded groups. With this benefit, the drugs listed are paid at 100 percent. This list is a separate benefit from the one that covers preventive service drugs under the Affordable Care Act.
Incentive Drug List for commercial groups
The Incentive Drug List offers select drugs with copays at a lower rate for some large employer groups.
Authorization and criteria
For certain prescription drugs, we have additional coverage requirements or limits. View prior authorization, quantity limits, step therapy, and more.
- Commercial Prior Authorization Criteria
- Commercial Step Therapy Criteria
- Commercial Exception Criteria for Formulary, Quantity Limits, and Tiers
- Commercial Weight Loss Formulary Exception Criteria - applies to select large employer groups only
- Commercial Prior Authorization Medication Exception Request Form
Drug list changes
PacificSource Drug Lists are updated regularly. Our team of physicians and pharmacists meet to recommend changes to our drug lists based on the latest medical studies and current clinical Food and Drug Administration guidelines.
- May 2023 Commercial Drug List Change Notification
- April 2023 Commercial Drug List Change Notification
- March 2023 Commercial Drug List Change Notification
- October 2022 Community Solutions Drug List Change Notification
- March 2022 Community Solutions Drug List Change Notification
Emergency fills for Washington commercial members
For urgently needed medications during our non-business hours.
We’re here to help
Please reach out to our Customer Service team with any questions you may have.
888-977-9299, TTY: 711
800-431-4135, TTY: 711
888-863-3637, TTY: 711
We accept all relay calls.