Provider Notices

Please Note: Prior to submitting our Provider Relief Emergency Temporary Practitioner Application, please verify if they are already contracted and a participating provider.

To confirm that your provider is considered participating, we have three convenient options for you to choose from.

  • Give us a call
    Oregon: (541) 684-5582 or (888) 977-9299
    Idaho: (208) 333-1596 or (800) 688-5008
    Montana: (406) 442-6589 or (877) 590-1596
  • Email us: cs@pacificsource.com
  • Go online

    You can find our online provider directory at PacificSource.com. Select the Find a Provider link from our top menu bar. On the right hand side of your screen, find the Quick Links menu and click on PacificSource Provider Directory.

    If you have any questions, please feel free to contact us at the numbers listed above.

Pharmacy Coverage Updates Effective December 15, 2019

10/8/2019 8:39:46 AM

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

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

Please review the summary of these changes below:

Drug Name

Change

Effective Date

Nplate SOLUTION RECONSTITUTED 250 MCG Subcutaneous

Add Prior Authorization

12/15/2019

Nplate SOLUTION RECONSTITUTED 500 MCG Subcutaneous

Add Prior Authorization

12/15/2019

Procrit SOLUTION 10000 UNIT/ML INJECTION

Add Prior Authorization

12/15/2019

Procrit SOLUTION 2000 UNIT/ML INJECTION

Add Prior Authorization

12/15/2019

Procrit SOLUTION 20000 UNIT/ML INJECTION

Add Prior Authorization

12/15/2019

Procrit SOLUTION 3000 UNIT/ML INJECTION

Add Prior Authorization

12/15/2019

Procrit SOLUTION 4000 UNIT/ML INJECTION

Add Prior Authorization

12/15/2019

Procrit SOLUTION 40000 UNIT/ML INJECTION

Add Prior Authorization

12/15/2019

Zytiga TABLET 500 MG Oral

Abiraterone Acetate Tablet 250 MG Oral

12/15/2019

Zykadia CAPSULE 150 MG ORAL

Update Quantity Limit to #90/30 days

12/15/2019

Ambrisentan Tablet 5 MG Oral

Add Quantity Limit # 30/30 days

12/15/2019

Ambrisentan Tablet 10 MG Oral

Add Quantity Limit # 30/30 days

12/15/2019

Bosentan Tablet 62.5 MG Oral

Add Quantity Limit # 60/30 days

12/15/2019

Bosentan Tablet 125 MG Oral

Add Quantity Limit # 60/30 days

12/15/2019

Methamphetamine HCl Tablet 5 MG Oral

Amphetamine-Dextroamphetamine Tablet, Dextroamphetamine Sulfate TABLET, Methylphenidate HCl Tablet, Dexmethylphenidate HCl Tablet

12/15/2019

Ondansetron HCl TABLET 24 MG ORAL

Ondansetron HCl Tablet 8 MG Oral

12/15/2019

Dexcom G6 Transmitter

Add Quantity Limit # 1/84 days

12/15/2019

Ezetimibe Tablet 10 MG Oral

Add Quantity Limit # 30/30 days

12/15/2019

Acyclovir Sodium Solution Reconstituted 500 MG Intravenous

Acyclovir Sodium SOLUTION 50 MG/ML Intravenous

12/15/2019

Kisqali 600 Dose Tablet 200 MG Oral

Add Quantity Limit # 63/28 days

12/15/2019

Kisqali 400 Dose Tablet 200 MG Oral

Add Quantity Limit # 42/28 days

12/15/2019

Kisqali 200 Dose TABLET 200 MG Oral

Add Quantity Limit # 21/28 days

12/15/2019

 

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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