Medical Drug Formulary Change Notification
This notification is to inform you of changes to our medical drug formulary.
Effective on 01/01/2021, our formulary prior authorization requirements will be updated. We are changing coverage of the following medications:
Liposomal Doxorubicin (Q2050)
Varubi oral (J8670)
Actions may be required:
Some medications do not have alternatives. Please consult with your patient if continuing certain medications is necessary.
If it is medically necessary for your patient to continue with a current medication, you may request a prior authorization. To request a prior authorization, please submit any pertinent documentation via the InTouch portal www.PacificSource.com/AboutProviderInTouch/ or call us at (844) 877-4803 if you need assistance.