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

April 2019. The following changes to the drug list are effective April 22, 2019:

Formulary Additions

  • Phytonadione tablet add to tier 1 with quantity over time limit
  • Mesalamine suppository add to tier 1 with quantity limit
  • Synagis solution add to tier 3 with SP and preauthorization
  • Fluticasone-Salmeterol aerosol powder breath activated add to tier 1 with quantity limit
  • Silodosin capsule add to tier 1 with quantity limit and step therapy
  • Omnipod Starter Kit add to tier 2
  • Sumatriptan succinate solution prefilled syringe add to tier 1 with quantity over time
  • Oralair Adult Sample Kit 300IR sublingual tablet add to tier 3 with medical necessity pre authorization
  • Oralair Children Starter Pack 100IR sublingual tablet add to tier 3 with medical necessity preauthorization
  • Oralair Adult Starter Pack 300IR sublingual tablet add to tier 3 with medical necessity preauthorization
  • Oralair Childrens Sample Kit 100 (3) & 300 (6) IR Therapy Pack add to tier 3 with medical necessity preauthorization
  • Finacea Foam add to tier 3
  • OmniPod add to tier 2 with quantity limit
  • Nityr tablet add to tier 3 with SP and preauthorization
  • HyperRAB S/D injection add to tier 3
  • HyperRAB injection add to tier 3
  • OmniPod Dash add to tier 3 with medical necessity preauthorization
  • OmniPod Dash System Kit add to tier 3 with medical necessity preauthorization
  • Ajovy solution prefilled syringe add to tier 3 with quantity limit and preauthorization
  • Emgality solution auto-injector add to tier 3 with quantity limit and preauthorization
  • Hailey 24 Fe tablet add to tier 0 with ACA restrictions
  • Actemra ACTPen solution auto-injector add to tier 3 with quantity limit and medical necessity preauthorization
  • Tirosint capsule add to tier 3
  • Aemcolo tablet delayed released add to tier 3
  • Firdapse add to tier 3 with SP and preauthorization
  • Seysara tablet add to tier 3 with medical necessity preauthorization
  • Gamifant solution add to tier 3 with SP and preauthorization
  • Krintafel tablet add to tier 3
  • Emgality solution prefilled syringe add to tier 3 with quantity limit and preauthorization
  • Wixela Inhub aerosol powder breath activated add to tier 1 with quantity limit
  • Albuterol Sulfate HFA aerosol solution add to tier 1 with quantity limit
  • V-Go Kit add to tier 3 with medical necessity preauthorization

Quantity Limit Update

  • Methylergonovine Maleate tablet– update quantity over time
  • Proventil HFA aerosol solution– add quantity limit
  • Ventolin HFA aerosol solution – add quantity limit
  • ProAir HFA aerosol solution – add quantity limit
  • Rapaflo capsule – add quantity limit
  • Rabeprazole sodium delayed release tablet– update quantity limit
  • Mephyton 5mg tablet – update quantity over time
  • Odactra sublingual tablet – add quantity limit
  • Oralair 300IR sublingual tablet – add quantity limit
  • Ragwitek sublingual tablet – add quantity limit
  • Grastek sublingual tablet – add quantity limit
  • Duzallo 200-200 mg tablet – add quantity limit
  • Duzallo 200-300 mg tablet – add quantity limit

Tier Update

  • Mephyton 5mg tablet
  • Proctosol HC 2.5% rectal cream

Preauthorization Updates

  • Odactra sublingual tablet – Remove preauthorization
  • Oralair sublingual tablet – add medical necessity preauthorization
  • Ragwitek sublingual tablet – remove preauthorization
  • Grastek sublingual tablet – remove preauthorization

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

March 2019. The following changes to the drug list are effective March 22, 2019:

Formulary Additions

  • Abiraterone tablet add Tier 1 with SP, partial fill and preauthorization
  • Adapalene solution add Tier 3 with medical necessity preauthorization
  • Albendazole tablet add Tier 1 with quantity over time limit
  • Amphetamine Sulfate tablet add Tier 1 with medical necessity preauthorization
  • Azelaic Acid gel add Tier 1
  • Bupropion ER 450mg tablet add Tier 1 with medical necessity preauthorization
  • Butalbital-Acetaminophen capsule add Tier 1 with quantity limit
  • Cequa solution add Tier 3 with medical necessity preauthorization
  • Clobazam tablet/suspension add Tier 1 with preauthorization
  • Colesevelam packet add Tier 1
  • Cyred EQ tablet add Tier 0 with ACA restrictions
  • Daurismo tablet add Tier 3 with SP and preauthorization
  • Desoximetasone spray add Tier 1
  • Dexamethasone therapy pack add Tier 1
  • DexPak add Tier 3
  • Dorzolamide-Timolol opth solution add Tier 1
  • Dupixent prefilled syringe add Tier 3 with SP, quantity limit and preauthorization
  • Ertapenem solution add Tier 1
  • Evekeo tablet add Tier 3 with medical necessity preauthorization
  • Flac oil add Tier 1
  • Gardasil 9 vaccine add Tier 0 with ACA restrictions
  • Granix solution add Tier 3 with SP, preauthorization
  • Hydrocortisone Butyrate lotion add Tier 1
  • Imiquimod pump cream add Tier 1 with medical necessity preauthorization
  • Itraconazole solution add Tier 1 with medical necessity preauthorization
  • Ketoprofen capsule add Tier 1
  • Lactulose packet add Tier 1 with step therapy
  • Ledipasvir-Sofosbuvir tablet add Tier 1 with SP, medical necessity preauthorization
  • Minocycline ER tablet add Tier 1 with medical necessity preauthorization
  • Mondoxyne capsule add Tier 1
  • Morphine sulfate ER capsule add Tier 1
  • Norditropin FlexPro add Tier 3 with SP, preauthorization
  • Nuzyra solution/tablet add Tier 3 with medical necessity preauthorization
  • Okebo capsule add Tier 1
  • Oxervate ophthalmic solution add Tier 3 with limited access and preauthorization
  • Pimecrolimus cream add Tier 1 with medical necessity preauthorization
  • Plixda pad add Tier 3 with medical necessity preauthorization
  • Promacta packet add Tier 3 with SP, preauthorization
  • Sofosbuvir-Velpatasvir add Tier 1 with SP, medical necessity preauthorization
  • TaperDex add Tier 3
  • Testosterone gel 1.62% add Tier 1 with preauthorization
  • Tolsura capsule add Tier 3 with medical necessity preauthorization
  • Udenyca solution add Tier 3 with SP and preauthorization
  • Vancomycin solution add Tier 3
  • Vitrakvi capsule add Tier 3 with SP, quantity limit and preauthorization
  • Vitrakvi solution add Tier 3 with SP and preauthorization
  • Xarelto tablet add Tier 2
  • Xospata tablet add Tier 3 with SP and preauthorization
  • Yupelri solution add Tier 3 with SP, preauthorization
  • Zortress tablet add Tier 3 with quantity limit

Quantity Limit Update

  • Albendazole tablet, celecoxib capsule, ezetimibe tablet, ezetimibe-simvastatin tablet, Vytorin tablet - add quantity limit
  • Venclexta tablet – update quantity limit
  • Zaleplon capsule – remove quantity limit

Step Therapy Update

  • Celecoxib capsule - remove step therapy

Tier Update

  • Norditropin FlexPro solution

Preauthorization Updates

  • Itraconazole solution, Kisqali tablet add medical necessity preauthorization
  • Modafinil tablet, Provigil tablet, Lovaza capsule – remove preauthorization

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

 

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

April: All States

April 2019. The following changes to the drug list are effective April 22, 2019:

Formulary Additions

  • Halobetasol Propionate ointment add to tier 1
  • Phytonadione tablet add to tier 1 with quantity over time
  • Mesalamine suppository add to tier 1 with quantity limit
  • Synagis solution add to tier 4 with SP and preauthorization
  • Fluticasone–Salmeterol aerosol powder breath activated add to tier 1 with quantity limit
  • Silodosin capsule add to tier 1 with quantity limit and step therapy
  • OmniPod Starter Kit add to tier 2
  • Ragwitek sublingual tablet add to tier 3 with quantity limit
  • OmniPod add to tier 2 with quantity limit
  • Nityr tablet add to tier 4 with SP and preauthorization
  • Odactra sublingual tablet add to tier 3 with quantity limit
  • Ajovy solution prefilled syringe add to tier 3 with preauthorization and quantity limit
  • Emgality solution auto-injector add to tier 3 with quantity limit and preauthorization
  • Hailey 24 Fe tablet add to tier 0 with ACA restrictions
  • Firdapse tablet add to tier 4 with preauthorization
  • Gamifant solution add to tier 4 with preauthorization
  • Emgality solution prefilled syringe add to tier 3 with quantity limit and preauthorization
  • Wixela Inhub aerosol powder breath activated add to tier 1 with quantity limit
  • Albuterol Sulfate HFA aerosol solution – add to tier 1 with quantity limit

Preauthorization Update

  • Grastek sublingual tablet – remove preauthorization

Quantity Limit Update

  • Methylergonovine Maleate tablet – add quantity over time
  • ProAir RespiClick aerosol powder breath activated – add quantity limit
  • Grastek sublingual tablet – add quantity limit

Removed from Formulary

  • Mephyton 5mg tablet; consider phytonadione 5mg tablet
  • Elidel 1% cream; consider pimecrolimus 1% cream
  • Finacea 15% gel; consider azelaic acid 15% gel
  • Rapaflo capsule; consider silodosin capsule
  • Vitamin D tablet, Vitamin D capsule

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

March: All States

March 2019. The following changes to the drug list are effective March 22, 2019:

Formulary Addition

  • Abiraterone tablet add Tier 4 with SP, preauthorization
  • Albendazole tablet add Tier 1 with quantity over time limit
  • Azelaic Acid gel add Tier 1
  • Clobazam tablet add Tier 1 with preauthorization
  • Clobetasol foam add Tier 1
  • Closevelam packet add Tier 1
  • Cyred EQ tablet add Tier 0 with ACA restrictions
  • Daurismo tablet add Tier 4 with SP, preauthorization
  • Dorzolamide-Timolol ophthalmic solution add Tier 1
  • Dupixent solution add Tier 4 with SP, quantity limit and preauthorization
  • Ertapenem solution add Tier 1
  • Flac oil add Tier 1
  • Imiquimod cream add Tier 1 with medical necessity preauthorization
  • Itraconazole solution add Tier 1 with medical necessity preauthorization
  • Ketoprofen capsule add Tier 1
  • Lactulose packet add Tier 1
  • Nalfon tablet add Tier 3 with step therapy
  • Oxervate solution add Tier 4 with SP, preauthorization
  • Pimecrolimus cream add Tier 1 with medical necessity preauthorization
  • Promacta packet add Tier 4 with SP, preauthorization
  • Uenyca solution add Tier 4 with SP, preauthorization
  • Vancomycin solution add Tier 3
  • Vitrakvi capsule add Tier 4 with SP, quantity limit and preauthorization
  • Xarelto tablet add Tier 2
  • Xeljanz tablet add Tier 4 with SP, quantity limit and preauthorization
  • Xeljanz XR tablet add Tier 4 with SP, quantity limit and preauthorization
  • Xolair solution add Tier 4 with SP, quantity limit and preauthorization
  • Xolair solution add Tier 4 with SP, quantity limit and preauthorization
  • Xospata tablet add Tier 4 with SP, preauthorization
  • Zortress tablet add Tier 2 with quantity limit

Preauthorization Update

  • Modafinil tablet– remove preauthorization

Quantity Limit Update

  • Celecoxib capsule, Ezetimibe tablet, Ezetimibe-Simvastatin tablet – add quantity limit
  • Venclexta – update quantity limit
  • Zaleplon capsule – remove quantity limit

Step Therapy Update

  • Celecoxib capsule, Ezetimibe tablet, Ezetimibe-Simvastatin tablet – remove step therapy

Removed from Formulary

  • Albenza tablet; consider Albendazole tablet
  • Cosopt PF solution; consider dorzolamide-timolol opth solution
  • Invanz solution; consider ertapenem solution
  • Kisqali tablet; consider Verzenio tablet, Ibrance capsule
  • Kristalose packet; consider lactulose
  • Lovaza capsule; consider Omega-3-acid Ethyl Esters capsule
  • Onfi tablet; consider clobazam tablet
  • Spranox Solution; consider fluconazole
  • Welchol packet; consider colesevelam packet
  • Zyclara cream; consider imiquimod cream 5%

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 3/20/2019