Prescription Drug Information and News

Our PacificSource Drug Lists are updated monthly.
Learn more about our PacificSource Drug Lists >  

Our drug lists are available in a searchable online format.  Find a Drug >   

Preferred Drug List (PDL) Changes

November 2018. The following changes to the drug list are effective November 22, 2018:

Formulary Additions

  • Tadalafil tablet add Tier 1 with quantity limit and preauthorization
  • Vesicare tablet add Tier 2 with step therapy
  • Rasagiline tablet add Tier 1 with quantity limit
  • Toviaz tablet add Tier 3 with step therapy
  • Vancomycin IV solution add Tier 1
  • Vibativ IV solution add Tier 3
  • Tropazone lotion add Tier 3
  • Neosalus lotion add Tier 3
  • Myrbetriq tablet add Tier 2 with step therapy
  • Utibron Neohaler add Tier 3 with quantity limit and medical necessity preauthorization
  • BromSite ophthalmic solution add Tier 3
  • Gelnique Pump add Tier 3 with step therapy
  • Eskata solution add Tier 3 with quantity limit and medical necessity preauthorization
  • Firvanq oral solution add Tier 2
  • Cimduo tablet add Tier 2
  • Lucemyra tablet add Tier 3 with SP, quantity limit and medical necessity preauthorization
  • Symtuza tablet add Tier 3
  • Kapspargo Sprinkle capsule add Tier 3
  • Macrilen packet add Tier 3 with preauthorization
  • Nuplazid tablet and capsule add Tier 3 with quantity limit and preauthorization
  • Tibsovo tablet add Tier 3 with quantity limit and preauthorization
  • Orilissa tablet add Tier 3 with quantity limit and preauthorization
  • Lokelma packet add Tier 3 with medical necessity preauthorization
  • Imvexxy insert add Tier 3 with medical necessity preauthorization

Quantity Limit Update

  • Levofloxacin 250mg tablet remove quantity limit
  • Tracleer tablet, Advair HFA, Advair Diskus, Symbicort, Breo Ellipta, Opsumit tablet, Xerese cream, Anoro Ellipta, Stiolto Respimat, Bevespi Aerosphere, Lynparza tablet, Tracleer, Ozempic solution  add quantity limit
  • Requip XL tablet update quantity limit

Step Therapy Update

  • Ozempic solution add step therapy

Tier Update

  • Epogen, Lupron Depot, Procrit, Zoladex implant, Avonex, Tarceva tablet, Trelstar, Sprycel tablet, Letairis tablet, Bystolic tablet, Trelstar Mixject, Toviaz tablet, Extavia, Stiolto Respimat

Preauthorization Update

  • Enablex tablet, Coreg CR capsule, Extavia, Xerese cream, Tracleer add medical necessity preauthorization
  • Ozempic solution remove preauthorization

Removed/Excluded from Formulary

  • Chlordiazepoxide-Clidinium capsule
  • Levocetirizine tablet and oral solution

See the  PacificSource Drug Lists page for the current drug list.

October 2018. The following changes to the drug list are effective October 22, 2018:

Formulary Additions

  • Afrezza powder cartridge add Tier 3 with medical necessity preauthorization
  • Aristada Initio prefilled syringe add Tier 3 with quantity limit, medical necessity preauthorization
  • Braftovi capsule add Tier 3 with limited access, quantity limit, preauthorization
  • Cuvitru solution add Tier 3 with SP, preauthorization
  • Diclofex DC cream therapy pack add Tier 3 with medical necessity preauthorization
  • Diclosaicin cream Therapy Pack add Tier 3 with medical necessity preauthorization
  • Fulphila prefilled syringe add Tier 3 with SP, preauthorization
  • Ingrezza capsule add Tier 3 with medical necessity preauthorization
  • Mektovi tablet add Tier 3 with limited access, quantity limit, preauthorization
  • Olmesartan-Amlodipine tablet add Tier 1 with quantity limit
  • Olmesartan-HCTZ-Amlodipine tablet add Tier 1 with quantity limit
  • Olmesartan-Hydrochlorothiazide (HCTZ) tablet add Tier 1 with quantity limit
  • Orencia prefilled syringe add Tier 3 with SP, quantity limit, medical necessity preauthorization
  • Yonsa tablet add Tier 3 with limited access, preauthorization

Quantity Limit Update

  • Verapamil ER, Verelan PM, Felodipine ER, Nifedipine ER osmotic release, Nifedical XL, Onglyza remove quantity limit
  • Vancocin, Vancomycin capsule, Donepezil, Aricept, Rivastigmine, Exelon, Symbyax, Flovent HFA, Ranexa, Flovent Diskus, Exforge, Azor, Desvenlafaxine succinate ER, Savella titration pack, Amlodipine-Valsartan-HCTZ, Exforge HCT, Flector, Promacta, Aricept add quantity limit
  • Verelan, Nisoldipine ER, Procardia XL, Pegridy starter pack, Xigduo, Avonex update quantity limit

Step Therapy Update

  • Paxil, Prozac, Wellbutrin, Zoloft, Buproprion, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Venlafaxine, Paxil, Citalopram, Effexor XR, Celexa, Venlafaxine ER, Prozac weekly, Paroxetine ER, Paxil CR, Olmesartan, Lexapro, Escitalopram, Wellbutrin (SR, XL), Buproprion ER (XL, SR), Pexeva, Olanzapine-Fluoxetine, Symbyax, Fluvoxamine ER, Viibryd, Fetzima, Trintellix, add step therapy

Tier Update

  • Benicar HCT, Glipizide XL, Exforge, Azor, Exforge HCT with Tier update

Preauthorization Update

  • Zipsor, Forfivo XL, Methyltestosterone, Striant, Pristiq, Edarbi  add preauthorization

Removed/Excluded from Formulary

  • Teveten HCT tablet

See the  PacificSource Drug Lists page for the current drug list. 

State-based Drug List (ID, MT, OR) Changes

November: All States

November 2018. The following changes to the drug list are effective November 22, 2018:

Formulary Addition

  • Tadalafil tablet add Tier 1 with quantity limit and preauthorization
  • Midazolam solution add Tier 1
  • Avonex add Tier 4 with SP, quantity limit and preauthorization
  • Aubagio tablet add Tier 4 with SP, quantity limit and preauthorization
  • Opsumit add Tier 4 with SP, quantity limit and preauthorization
  • Stiolto Respimat add Tier 2 with quantity limit
  • Lynparza tablet add Tier 4 with SP, limited access, partial fill, quantity limit and preauthorization
  • Ozempic solution add Tier 2 with step therapy, quantity limit and preauthorization
  • Cimduo tablet add Tier 2
  • Macrilen packet add Tier 4 with SP and preauthorization
  • Nuplazid tablet/capsule add Tier 4 with SP, quantity limit and preauthorization
  • Tibsovo tablet add Tier 4 with SP, quantity limit and preauthorization
  • Orilissa tablet add Tier 3 with quantity limit and preauthorization

Quantity Limit Update

  • Levofloxacin 250mg tablet remove quantity limit
  • Rasagiline tablet, Advair HFA, Advair Diskus, Symbicort, Letairis tablet, Rebif solution add quantity limit

Tier Update

  • Vesicare tablet, Bystolic tablet, Toviaz tablet, Myrbetriq tablet, Breo Ellipt

Removed from Formulary

  • Tracleer tablets; consider Opsumit, Letairis
  • Extavia; consider Avonex, Betaseron, Plegridy, Rebif
  • Chlordiazepoxide-Clidinium capsule, Levocetirizine solution/tablet

See the  PacificSource Drug Lists page for the current drug list.

October: All States

October 2018. The following changes to the drug list are effective October 22, 2018:

Formulary Additions

  • Amlodipine-Valsartan add Tier 1 with quantity limit
  • Braftovi capsule add Tier 4 with limited access, quantity limit, preauthorization
  • Cuvitru Solution add Tier 4 with SP, preauthorization
  • Mektovi tablet add Tier 4 with limited access, quantity limit, preauthorization
  • Olmesartan-Amlodipine tablet add Tier 1 with quantity limit
  • Olmesartan-HCTZ-Amlodipine tablet add Tier 1 with quantity limit
  • Olmesartan-Hydrochlorothiazide (HCTZ) tablet add Tier 1 with quantity limit
  • Yonsa tablet add Tier 4 with limited access, preauthorization

Quantity Limit Update

  • Verapamil ER, Felodipine ER, Nifedipine ER osmotic release remove quantity limit
  • Nisoldipine ER, Plegridy starter pack update quantity limit
  • Vancomycin capsule, Rivastigmine, Olmesartan, Flovent HFA, Flovent Diskus, Arnuity Ellipta, Savella titration pack, Donepezil add quantity limit

Step Therapy Update

  • Buproprion, Fluvoxamine, Fluoxetine 90mg weekly, Buproprion (XL, SR), Desvenlafaxine ER succinate, Fluvoxamine ER  add step therapy
  • Lisinopril, Benazepril, Captopril-HCTZ, Captopril, Enalapril, Enalapril-HCTZ, Fosinopril, Lisinopril-HCTZ, Quinapril, Ramipril, Perindopril, Amlodipin-Benazepril, Losartan, Losartan-HCTZ, Moexipril, Trandolapril, Irbesartan, Valsartan-HCTZ, Candesartan, Telmisartan, Irbesartan-HCTZ, Eprosartan, Candesartan-HCTZ, Olmesartan, Amlodipine-Benazepril, Tekturna, Candesartan-HCTZ, Edarbi remove step therapy

Preauthorization Update

  • Danazol capsule remove preauthorization
  • Methyltestosterone, Edarbi add preauthorization

Removed from Formulary

  • Mentax cream; consider clotrimazole cream, econazole cream, ketoconazole cream
  • Venlafaxine ER tablets; consider Venlafaxine ER capsules

See the PacificSource Drug Lists page for the current drug list.

Non-FDA Approved Compounding Agents

A compounded medication is when a pharmacist combines multiple ingredients together. Compounded claims often use what we called "bulk powders." These powders act as a mixing agent/congealing agent to hold the finished product together. These ingredients may not always be approved by the Food and Drug Administration (FDA), thus may not have been reviewed for safety and efficacy. To ensure you are taking medications proven to be safe and effective, beginning August 1, 2017, the non-FDA approved ingredients will be removed from coverage on your plan.

Examples of common non-FDA approved agents:

  • Cellulose (bulk) powder
  • Alcohol, usp 95%
  • Cream base
  • Fatty acid base
  • Gelatin capsules (empty)
  • Hypromellose (bulk) powder
  • Hormone cream base
  • Propylene glycol liquid
  • Thyroid powder
  • Silica gel
  • Stevia (bulk) powder
  • Vitamin E acetate (bulk) liquid

See the non-FDA approved bulk powder agents for the full list >

“Partial Fill” Lets a Patient Test a New Prescription

As you know, some drugs not only have a high cost, but have side effects that make them hard to tolerate for long-term use. Beginning February 22, 2016, these medications will be dispensed in a limited amount, on the first fill only, for half the normal copay. This “partial fill” will act as a trial period to see if the patient is able to successfully take the drug. 

A week into the first fill, a Caremark Specialty Care Team pharmacist or nurse will contact the patient. They will check on side effects and see if the patient was able to tolerate the drug. The Care Team will also answer questions and concerns about the treatment. If the trial period is a success, the patient will continue the drug. After this initial trial, all future fills will be for the full amount. 

On our drug lists, partial-fill drugs are identified by “Partial Fill” in the Restrictions column.

Partial-fill drugs include:

  • Afinitor
  • Bosulif
  • Erivedge
  • Gleevec
  • Inlyta
 
  • Jakafi
  • Nexavar
  • Odomzo
  • Sprycel
  • Sutent
 
  • Tafinlar
  • Tarceva
  • Targretin
  • Tasigna
  • Votrient
 
  • Xalkori
  • Xtandi
  • Zolinza
  • Zykadia
  • Zytiga
 

Preauthorization and Step Therapy Drug Lists with Criteria

Our Preauthorization Policies and Step Therapy Policies documents contain lists of drugs that require preauthorization or that are Step Therapy drugs, as well as their criteria. These two documents replace the one-page "PDL/VDL Preauthorization and Step Therapy Drug Lists" document. You may also use Preauthorization Policies to access our coverage rules for compound medications.

Flu and Pertussis Vaccination Coverage

Our flu vaccination page now includes information about your coverage for whooping cough (pertussis), as well as seasonal flu vaccination and general information.

Consumer Updates from the FDA

Quick Links

PacificSource Drug Lists—our comprehensive drug list page

Preventive Drug List

Incentive Drug List

Prescription drug claim form

Prescription Drug Preauthorization Request (Fax)

InTouch for Members

Are you a Medicare or Medicaid member?

If so, we have a website just for you!

Cool Tools for Managing Your Rx

On the CVS Caremark® website, you'll find tools to help you track pharmacy expenses, save on drug costs, manage your prescriptions, and more. Register by using the member ID number and group code on your ID card. To start, visit Caremark.com.

Why Choose Generics?

Generic prescription medicines are safe, effective, and a good value. Save money by using them instead of brand name drugs whenever possible.

Questions?

Contact our Pharmacy Services Department:

  • Phone: (541) 225-3784
  • Toll-free: (844) 877-4803
  • Email: Use our online Contact Us form
Last updated 10/19/2018