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Provider Notices
Pharmacy Coverage Updates Effective December 15, 2020
10/14/2020 3:06:27 PMWe 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, 2020.
Please review the summary of these changes below:
|
Drug Name |
Change |
Effective Date |
|---|---|---|
|
Corlanor |
Add QL of 60 tablets per 30 days 450 mls/30 days |
12/15/2020 |
|
Simponi SQ
|
|
12/15/2020 |
|
Taltz
|
Remove from formulary
|
12/15/2020 |
|
Palforzia |
Remove from formulary |
12/15/2020 |
|
Doxycycline monohydrate capsules |
Remove 75mg and 100mg from formulary |
12/15/2020 |
|
Doxycyline Hyclate tablets |
Remove 50mg and 100mg from formulary |
12/15/2020 |
|
Tecfidera |
Remove brand name product from formulary (generic available) |
12/15/2020 |
|
Jardiance Invokana |
Move from step therapy to prior authorization |
12/15/2020 |
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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