PacificSource Drug Lists
The PacificSource Preferred and Value Drug Lists are guides to help your doctor identify medications that can provide the best clinical results at the lowest cost.
Although they are not on this list, all covered generic drugs are available for your plan’s Tier 1 generic copay. Compounded prescriptions and brand name drugs not listed here are nonpreferred and are available for your plan’s Tier 3 copay (unless the drug is excluded, and therefore, not covered by the plan). This list is subject to change, as new drugs are constantly entering the market.
Please note: Some plans only provide coverage for certain drugs on this list. A separate benefit may apply to some drugs, such as specialty drugs. If you have questions about your coverage, please contact our Customer Service Department at (888) 977-9299 or by email at email@example.com.
For information about how to read the chart below, see our Drug List Abbreviations and Terms list.
Drug News—See what changes have been made recently.
Drug List Abbreviations and Terms
Drug List Information
Incentive Drug List
Preauthorization and Step Therapy Drug Lists
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.