Drug Preauthorizations and Exemptions

Preauthorization and Step Therapy Drugs

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. “PA” in the requirements column of a drug list means the drug requires preauthorization.

Step Therapy is a different form of preauthorization, which requires a trial of one or more prerequisite medications before a Step Therapy medication will be covered. If it is medically necessary for a member to use a Step Therapy medication as initial therapy, the treating physician can request coverage of such drug as a medical exception by submitting a Prior Authorization Request Form. “ST” in the requirements column of a drug list means the drug requires Step Therapy preauthorization.

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: 

  • The medication was covered by your previous insurance company and you were using it within the 120 days before coming to PacificSource.

  • The medication is not excluded under your PacificSource plan.

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/non-formulary drug and don’t have a nonpreferred/non-formulary drug benefit, you or your doctor can request an addition to the 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 drug list.


InTouch for Members

Last updated 10/1/2013