Drug List Abbreviations and Terms

2 or 3

The numbers 2 and 3 refer to drug copay tiers. Tier 1 drugs are generics and are not included in this list. For Tier 2 drugs you will pay the copay for preferred brands (also called “formulary” drugs). For Tier 3 drugs you will pay the copay for nonpreferred brands (also called “nonformulary” drugs). If you also see SP in the Requirements column of the drug list table, it means the drug is a specialty drug and your plan’s specialty drug copay applies, which may be higher than the Tier 2 or Tier 3 copay.

Comments

The Comments section includes listings for lower-cost alternatives, descriptions of quantity limits, and other helpful information.

Generic

A check in the Generic Available column means a generic equivalent for the drug is available. Although they are not on our drug list, all generic drugs are available for your plan’s Tier 1 generic copay (unless they are excluded from the plan).

M

Covered under your medical plan.

PA

If PA appears in the Requirements column, the drug requires preauthorization from your physician before the drug will be covered.

PDL

PDL stands for Preferred Drug List. This 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.

QL

QL stands for quantity limits. If QL appears in the Requirements column, the drug 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 fax a preauthorization request to us.

SP

SP stands for specialty or biotech drug, which are used to treat chronic or genetic disorders. In most cases, specialty drugs require a higher copay than other Tier 2 or Tier 3 drugs. Check your Member Handbook or Summary of Benefits to find the specialty drug copay amount.

ST

ST stands for Step Therapy, a program that requires you to try a lower-cost alternative medication (“Step 1 drugs”) before using the more expensive (“Step 2”) medication. If it is medically necessary for you to use a Step 2 medication as initial therapy, your provider can submit a preauthorization request to us. 

VDL

VDL stands for Value Drug List. This 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.