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Provider Notices

Pharmacy Coverage Updates Effective October 15, 2021

8/13/2021 4:22:18 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 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


Remove Brand

(generic available)

 

 

10/15/2021

 

Novolog Mix suspension and FlexPen

 

Remove Brand

(biosimilar available)

 

10/15/2021


Intelence tablets

 

 

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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