PacificSource Drug List Information
The Preferred Drug List (PDL) and Value Drug List (VDL) are guides to help your doctor identify medications that can provide the best clinical results at the lowest cost.
To find out which list applies to your pharmacy plan, check your Summary of Benefits—available online through your InTouch account or from your benefits administrator. You are also welcome to call our Customer Service Department for assistance.
Most drug lists are reviewed and updated monthly. To see what changes have been made recently, please visit our Drug News page.
Our drug list is available in a searchable online format. You can switch between the Value and Preferred lists with the click of your mouse. You'll also have the option to view and print an entire list or just your search results.
Our PacificSource Drug List
Our comprehensive PacificSource Drug List page includes:
- PacificSource PDL (Preferred Drug List)—applies to PacificSource pharmacy plans that have PDL listed in the Preferred Drugs section of the plan’s Summary of Benefits. This list includes approximately 430 preferred brand name prescription medications and is updated monthly.
- PacificSource VDL (Value Drug List)—applies to our Tiered Value prescription drug plan and any pharmacy plan that has the VDL listed in the Preferred Drugs section of the Summary of Benefits. This list includes approximately 120 preferred brand name prescription medications and is updated monthly.
For each drug on our lists, find additional information and requirements, including:
- Copay Tier—Different drugs have different copays depending on which category or “tier” they are in. Tier 1 drugs are generic drugs and typically have the lowest copays. Tier 2 drugs are your plan’s preferred brand drugs (sometimes called “formulary” drugs). Tier 3 drugs, also called “nonformulary” drugs, are nonpreferred brands. These Tier 3 drugs typically have the highest copays.
- A copay tier of “M” means the medication is covered under your plan’s medical benefit instead of the pharmacy benefit.
- Generic Available—A check in the Generic Available column means a generic equivalent for the drug is available.
- Preauthorization (PA)—Preauthorization helps encourage safe, cost-effective use of prescription drugs by requiring a "prior authorization" request from your physician before the drug will be covered. If your medication requires preauthorization, your provider can submit a preauthorization request to us for review via fax or online through InTouch.
- Specialty Drug (SP)—Specialty and biotech drugs are used to treat chronic or genetic disorders. Depending on your plan, specialty drugs may have a different copay than other drugs in the same copay tier.
- Step Therapy (ST)—Step Therapy is a program that requires you to try lower-cost alternative medications (“Step 1” drugs) before using more expensive medications (“Step 2” drugs). The program will only cover brand or Step 2 medications if less expensive Step 1 and/or generic medications in the same therapeutic class have been tried first.
- Quantity Limits (QL)—Certain medications may be covered by your plan, but only up to a certain quantity or limit. If you need quantities higher than the limit shown, have your provider submit a preauthorization request to us.
Our Incentive Drug List
Our Incentive Drug List applies to all plans that have Incentive Drug List copays shown on the Summary of Benefits. The Incentive Drug List is used in addition to your plan’s regular pharmacy benefit and includes drugs that are a lower-cost alternative to Tier 2 or Tier 3 copay drugs. It is updated annually.
Our Preauthorization and Step Therapy Drug Lists
Our Preauthorization and Step Therapy Drug Lists include drugs that require preauthorization or are Step Therapy drugs. This document is updated monthly.
Continuation of Therapy
If your group is new to PacificSource and you have been taking a medication that would normally require preauthorization from us, we help ease your transition by allowing you to fill the medication for the first 90 days without going through the preauthorization process. Our only requirements are that:
Please note that step therapy requirements; quantity limits; and age, gender, and dosage criteria still apply.
To continue to fill the medication beyond the initial 90 days, your provider will need to submit a preauthorization request to us for review.
Requesting Drug List Additions
If you have a prescription for a nonpreferred drug and don’t have a nonpreferred drug benefit, you or your doctor can request an addition to the Preferred Drug List. Please mail your written request to:
PacificSource Health Plans
Attn. Pharmacy Services
PO Box 7068
Springfield, OR 97475-0068
The PacificSource Pharmacy and Therapeutics Committee considers requests on a quarterly basis in February, May, August, and November. Once we receive your request, we will notify you of the date your request will be reviewed. After the review, we will notify you of the Committee’s decision. There is no guarantee that any change will be made to the Preferred Drug List.
For answers to many common questions about our drug lists and pharmacy benefits, see the Prescription Drugs section of our FAQ. You are also welcome to contact our Pharmacy Services Department at (541) 225-3784 or (800) 624-6052, ext. 3784, or use our online Contact Us form.