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Update to codes requiring prior authorization

Effective August 16, 2021, Pacificsource will require prior authorization for the following codes: 61791 (Creation, Lesion, Stereotactic, Percutaneous, Neurolytic Agent; Trigeminal Medullary Tract) 77399 (Unlisted Proc, Radiation/Physics/Dosimetry & Treatment Devices & Special Services...

July 2021 Drug List Change Notification

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 period recap

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...

How the American Rescue Plan affects COBRA and dependent care plans

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...

June 2021 Drug List Change Notification

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...