Coverage Updates Effective May 15, 2014 - Medicaid Formulary

8/6/2014 11:12:49 AM

We would like to inform you of changes to our PacificSource Community Solutions’ formulary and coverage policies, which took effect on May 15, 2014. These formulary changes were primarily implemented to provide additional coverage for our members. While we did not intend to make changes that would negatively affect our members, it has come out our attention that some disruption is occurring.

This disruption is being caused by configuration errors that previously allowed medications to be covered inadvertently. Examples include multi-vitamins for adults and some medications that are not funded by the Oregon Health Plan due to the prioritized list of covered services. We are reaching out to encourage you to bring these situations to our attention. Members who have been established on a therapy due to a previous configuration error will be allowed a 60-day transition fill. Providers may also choose to submit a formulary exception request for longer-term coverage.

Please review the summary of these changes below:  

Drug Name Medicaid Formulary
Below the Line Medications Removed Below the Line Medications: Defined by Oregon Health Authority (ex. antifungal creams, pseudoephedrine, and hemorrhoid treatments). For further prioritized list information refer to www.Oregon.gov/OHA/herc/Pages/PrioritizedList.aspx
Brand Name Products Removed Brand: generic equivalents on formulary

 
In addition to the above changes, we have updated the formulary to include a number of new medications that have been released in the last year. For a complete formulary listing, please visit our website at www.CommunitySolutions.PacificSource.com.

If you have questions regarding these changes, please contact your PacificSource Provider Service Representative or the PacificSource Pharmacy Services Department at (888) 437-7728 or (541) 330-4999.


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