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Provider Notices
Pharmacy Coverage Updates Effective October 15, 2021
8/13/2021 4:22:18 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 October 15, 2021.
Please review the summary of these changes below:
|
Drug Name |
Change |
Effective Date |
|---|---|---|
|
Banzel tablets
|
Remove Brand (generic available) |
10/15/2021 |
|
Kaletra tablets |
(generic available)
|
10/15/2021 |
|
Novolog Mix suspension and FlexPen |
Remove Brand (biosimilar available) |
10/15/2021 |
|
|
Remove Brand (generic available) |
10/15/2021 |
|
Potassium Chloride oral solution 20% (40mEQ/15mL) |
Remove Strength (alternate strengths available) |
10/15/2021 |
|
Potassium Chloride 20 mEQ oral packet
|
Remove Strength (alternate strengths available)
|
10/15/2021 |
|
Brovana solution |
Remove Brand (generic available) |
10/15/2021 |
|
Alinia tablets |
Remove Brand (generic available) |
10/15/2021 |
|
Truvada tablets |
Remove Brand (generic available) |
10/15/2021 |
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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