PacificSource Drug Lists

General Information

The PacificSource drug lists are guides to help your doctor identify medications that can provide the best clinical results at the lowest cost.

To find out which list applies to your pharmacy plan, check your PacificSource member ID card or Summary of Benefits—available online through your InTouch account or from your benefits administrator. If no drug list information appears on your ID card, use the "PDL" list. You are also welcome to call our Customer Service team for assistance.

Only the drugs on the list are covered by your plan. However, if you take a drug that is not listed, your doctor may request an exception. Our drug lists are 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 cs@pacificsource.com. Most drug lists are reviewed and updated monthly. To see what changes have been made recently, please visit our Drug News page.

See our Drug Preauthorizations and Exemptions page for more information.

Our PacificSource Drug Lists

Our drug lists are available in a searchable online format. You'll also have the option to view and print an entire list or just your search results.

Our comprehensive PacificSource Drug List page includes:

State drug lists Our Idaho Drug List (ID or IDL), Montana Drug List (MT or MDL), and Oregon Drug List (OR or ODL) are used by the majority of our members covered through employers or who have an individual and family plan.
PacificSource PDL
(Preferred Drug List)
The PDL applies to PacificSource pharmacy plans that have PDL listed in the Preferred Drugs section of the plan’s Summary of Benefits. This list is updated monthly. This list is typically for members who are covered employers who have not transitioned to state-based drug lists.

Drug List Abbreviations and Terms

For each drug on our lists, find additional information and requirements, including:

Tier

The numbers refer to drug copay tiers. Tier 0 drug copays are waived under the Affordable Care Act. Tier 1 drugs have the lowest copay and are typically generics. For Tier 2 drugs you will have a mid-range copay. For Tier 3 drugs you will have a high copay. Tier 4 drugs are specialty drugs.

Comments

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

PA

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

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. 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.Tier 4 drugs are specialty drugs.

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 an exception request to us. 

For more insurance terms, please see our Glossary.

Our Preventive Drug List 

For 2017: The Preventive Drug List is included in our Affordable Care Act (ACA) qualified plans for individuals and small groups, and it is an optional benefit for large groups. With this benefit, the preventive drugs are paid at 100 percent. View full list of covered preventive drugs.

For 2018: The Preventive Drug List is included in our ACA qualified plans for individuals and small groups, and standard large group plans with the state-based drug list. With this benefit, the preventive drugs are paid at 100 percent. View full list of covered preventive drugs.

Our Incentive Drug List

Our Incentive Drug List applies to all plans that have Incentive Drug List copays shown on the Summary of Benefits. The Incentive Drug List is used in addition to your plan's regular pharmacy benefit and includes drugs that are a lower-cost alternative to Tier 2 or Tier 3 copay drugs. 

Questions?

For answers to many common questions about our drug lists and pharmacy benefits, see the Prescription Drugs section of our FAQ.

You are also welcome to contact our Pharmacy Services team at (541) 225-3784 or (800) 624-6052, ext. 3784, or use our online Contact Us form.

InTouch for Members

Prescription Discount Program

If you have a medical plan with us, just show your PacificSource ID card at a CVS Caremark® network pharmacy, and you’ll receive a discount on any drugs not covered by your plan. Learn more.

Mail Order Service

We partner with both CVS Caremark® and Wellpartner Pharmacy. If your plan includes prescription drug coverage, mail order is a convenient, cost-saving option. Learn more.

Last updated 8/28/2017