Articles

Updates on Existing Criteria: October 2021. The following changes to criteria are effective October 22, 2021: Prior Authorization Criteria – Clinical Updates Addyi & Vyleesi – Update exclusion criteria Benralizumab - add Pulmonologist as allowed...

To simplify how members and providers work with us, PacificSource has announced changes to our network beginning Jan. 1, 2022. Once the changes are complete, we will serve members across the region through two provider networks: Navigator and Voyager. In Oregon,...

Updates on Existing Criteria: September 2021. The following changes to criteria are effective September 22, 2021: Prior Authorization Criteria – Clinical Updates Botox – Update exclusion criteria Krystexxa – For chronic gout, clarified required trial...

Effective August 30, 2021, PacificSource will require prior authorization for the following codes related to Optical Coherence Tomography for Cardiac CPT/HCPC: ...

Updates on Existing Criteria August 2021. The following changes to criteria are effective August 22, 2021:
Prior Authorization Criteria – Clinical Updates Antidiabetic Step Therapy – Add exception bullet for Farxiga new indication of chronic kidney...

Updates on Existing Criteria July 2021. The following changes to criteria are effective July 22, 2021: Prior Authorization Criteria – Clinical Updates Arcalyst – add new indication of Recurrent Pericarditis Juxtapid – combine policy with new drug Evkeeza...

Special enrollment periods (SEP) in Idaho, Montana, Oregon, and Washington began in February or March. SEPs may include consumers on and off the exchange. Because each state has its own rules and dates, we’re providing a recap of dates and information about changing plans. Note about...

The American Rescue Plan (ARP) Act of 2021 includes COBRA subsidies and increases dependent care account maximums to help Americans. COBRA premium assistance Individuals may have 100% of COBRA premiums paid for a period of up to six months beginning on April 1, 2021.  Individuals will have a...

Updates on Existing Criteria: June 2021. The following changes to criteria are effective June 22, 2021: Prior Authorization Criteria – Clinical Updates Botox – Update appropriate treatment for bladder conditions Muscular Dystrophy RNA Therapy – Add Amondys 45...