Provider Notices


Pharmacy Coverage Updates Effective April 15, 2019

2/14/2019 9:48:05 AM

We would like to inform you of changes to our PacificSource Community Solutions’ formulary and coverage policies related to opiate agents.

We have recently updated our prior authorization list and coverage policies. These changes are effective for dates of service on or after April 15, 2019.

Please review the summary of these changes below:

The Centers for Disease Control, Oregon Health Authority, and the Centers for Medicare and Medicaid Services have lowered their recommended daily Morphine Milligrams Equivalents (MME). In light of these new recommendations, PacificSource will initiate a limit of 100 MME on April 15, 2019 with a goal of moving down to 90 MME over the next few months. This does not apply if patients are in hospice or have active cancer or sickle cell disease. For instances where patients are receiving additional opioids for acute pain management (i.e. recent trauma or surgery), proper documentation needs to be given for approval.

In response to the CDC, OHA and CMS opioid recommendations, we will apply the following limits on the dates identified below:

   Change

   Effective Date

  Total opioid use above 100 morphine milligram equivalents (MME) per day requires Prior Authorization

   April 15, 2019

  Total opioid use above 90 morphine milligram equivalents (MME) per day requires Prior Authorization

   June 17, 2019

 

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 CommunitySolutions.PacificSource.com/Tools/DrugSearch.

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.

 

Sincerely,

Provider Network


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