Provider Notices

Pharmacy Coverage Updates Effective October 1, 2019

8/30/2019 4:56:26 PM

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 October 1, 2019.

Please review the summary of these changes below:

The Center for Medicaid and Medicare Services (CMS) and Oregon Health Authority (OHA) are making changes to the coverage of opioids. CMS has identified that prescriptions for acute event treatments are often excessive and can lead to misuse. To combat this risk, CMS and OHA are requiring health plans to implement certain limits on new prescriptions for opioids. These changes will take effect October 1, 2019.


   Effective Date

  7-day supply limit for patients who are new starts to opioid therapy

   October 1, 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

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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