News and updates
July 2024 Drug List Change Notification (Commercial)
Updates on Existing CriteriaJuly 2024. The following changes to criteria are effective July 22, 2024:Prior Authorization Criteria –...
Most Change Healthcare services restored
Clearinghouse services provided by Change Healthcare have been mostly restored, including eligibility status, remittance advice, and claims transmission, following a February cybersecurity event....
Information for HRSN service providers
Here’s what providers should know if they want to provide health-related social needs (HRSN) services.Qualifications and process for becoming an HRSN service providerTo become an HRSN service...
Oregon’s Access to Primary Care law
Important details and what to expect Note: This law applies only to Oregon members who are covered by individual/family and fully insured...
Understanding Oregon Senate Bill 1529 access to primary care requirements
Oregon Senate Bill 1529, now in effect, intends to expand access to care and improve health outcomes. The following is an overview of the law’s key requirements and what you can expect from...
June 2024 Drug List Change Notification (Commercial)
Updates on Existing CriteriaJune 2024. The following changes to criteria are effective June 22, 2024:Prior Authorization Criteria –...
Change Healthcare cybersecurity event: what to know and do
On Wednesday, February 21, 2024, Change Healthcare, one of our clearinghouse partners, was impacted by a cybersecurity event. This event compelled them to suspend business with all...
Pharmacy coverage updates effective May 15, 2024 (Medicaid)
We have recently updated our prior authorization list and coverage policies. These changes are effective for dates of service on or after May 15, 2024....
Humira coverage is changing for commercial PacificSource members
Beginning June 22, 2024, coverage of Humira (adalimumab) through PacificSource Health Plans will change to other, biosimilar formulations. This change applies to commercial (Employer and Individual...
May 2024 Drug List Change Notification (Commercial)
Updates on Existing CriteriaMay 2024. The following changes to criteria are effective May 22, 2024:Prior Authorization Criteria – Clinical...