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March Drug List Change Notification

Updates on Existing Criteria March 2022. The following changes to criteria are effective March 22, 2022: Prior Authorization Criteria – Clinical Updates Adenosine Deaminase (ADA) Replacement – update prescriber restrictions and dose rounding Arcalyst – update...

February Drug List Change Notification

Updates on Existing Criteria February 2022. The following changes to criteria are effective February 22, 2022: Prior Authorization Criteria – Clinical Updates Abemaciclib – update to include new breast cancer indication including coverage for Ki-67 biomarker...

January 2022 Drug List Change Notification

Updates on Existing Criteria January 2022. The following changes to criteria are effective January 22, 2022: Prior Authorization Criteria – Clinical Updates Belumosudil – remove stand-alone policy and add to general Oncology Agents criteria ...

December 2021 Drug List Change Notification

Updates on Existing Criteria: December 2021. The following changes to criteria are effective December 22, 2021: Prior Authorization Criteria – Clinical Updates Anti-Cataplectics – rename Oxybates and update to include new Xywav indication of idiopathic...

Pre-payment audits resumed Oct. 15

After a brief pause, PacificSource has resumed auditing pre-payment hospital claims, beginning October 15, 2021.  The policy document is available upon request and your Provider Service Representative is available to answer your questions.

Philips CPAP/BiPAP recall information

On June 14, 2021, Philips issued a recall notification for specific affected ventilation and sleep apnea devices. The notification informs patients, users, and customers of potential impacts on patient health and clinical use related to this issue.  If you represent a U.S. durable medical...

November 2021 Drug list Change Notification

Updates on Existing Criteria:  November 2021. The following changes to criteria are effective November 22, 2021: Prior Authorization Criteria – Clinical Updates Alemtuzumab – update required medical information and prescriber restrictions ...

October 2021 Drug list Change Notification

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...

September 2021 Drug list Change Notification

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...
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