Our office-space closures help ensure community and employee safety
In our effort to slow the spread of COVID-19, PacificSource office locations remain closed. Until further notice, we’re unable to accommodate any walk-in visitors. As always, our Customer Service team is glad to answer your questions by phone or email. Let us know how we can help!
Contact Us

Provider Notices

Pharmacy Coverage Updates Effective 09/15/2020

7/15/2020 5:06:19 PM

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 09/15/2020.

Please review the summary of these changes below:


Drug Name



Effective Date

Proair and Proair respiclick

Remove from formulary


Albuterol HFA, Ventolin HFA, Levalbuterol


Novolog Flexpen Novolog Solution

Remove from formulary


Admelog, Insulin Lispro, Insulin Aspart


Xopenex HFA

Remove from formulary


Albuterol HFA, Ventolin HFA, Levalbuterol


Betamethasone Dipropionate ointment and cream

Add Quantity Limit of 90 grams per 30 days

















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.


Provider Network