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Provider Notices
Pharmacy Coverage Updates Effective February 15, 2021
12/15/2020 3:00:13 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 February 15, 2021.
Please review the summary of these changes below:
|
Drug Name |
Change |
Effective Date |
|---|---|---|
|
Apriso 0.375gm capsules
|
Remove Brand (Generic available) |
2/15/2021 |
|
Truvada 200-300mg tablets |
Remove Brand (Generic available) |
2/15/2021 |
|
Atripla 600-200-300 tablets |
Remove Brand (Generic available) |
2/15/2021 |
|
|
Remove Brand (Generic available) |
2/15/2021 |
|
Amicar 500mg tablets Amicar 1000mg tablets |
Remove Brand (Generic available) |
2/15/2021 |
|
Kuvan 100mg packet Kuvan 500mg packet Kuvan 100mg dispersible tablet |
Remove Brand (Generic available) |
2/15/2021 |
|
Samsca 15mg tablets Samsca 30mg tablets |
Remove Brand (Generic available) |
2/15/2021 |
|
Symfi 600-300-300mg tablets Symfi Lo 400-300-300 tablets
|
Remove Brand (Generic available) |
2/15/2021 |
|
Carafate suspension |
Remove Brand (Generic available) |
2/15/2021 |
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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