Our office-space closures help ensure community and employee safety
In our effort to slow the spread of COVID-19, PacificSource office locations remain closed. Until further notice, we’re unable to accommodate any walk-in visitors. As always, our Customer Service team is glad to answer your questions by phone or email. Let us know how we can help!
Contact Us

Drug Changes

Here you will find a listing of the drugs that have been changed on our drug list (formulary) for the indicated plan year.


Zepatier TABLET 50-100 MG ORAL


Post Date:
1/24/2020
Effective Date:
1/24/2020
Type of Change:
Drug removed
Reason Changed:
Oregon Health Authority Risk Corridor changes

Betamethasone Dipropionate Cream 0.05 % External


Post Date:
9/14/2020
Effective Date:
9/15/2020
Type of Change:
Utilization management added
Reason Changed:
Quantity limit updated

Betamethasone Dipropionate Ointment 0.05 % External


Post Date:
9/14/2020
Effective Date:
9/15/2020
Type of Change:
Utilization management added
Reason Changed:
Quantity limit updated

Xopenex HFA Aerosol 45 MCG/ACT Inhalation


Post Date:
9/14/2020
Effective Date:
9/15/2020
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

NovoLOG FlexPen Solution Pen-Injector 100 UNIT/ML Subcutaneous


Post Date:
9/14/2020
Effective Date:
9/15/2020
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

NovoLOG PenFill Solution Cartridge 100 UNIT/ML Subcutaneous


Post Date:
9/14/2020
Effective Date:
9/15/2020
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

NovoLOG Solution 100 UNIT/ML Subcutaneous


Post Date:
9/14/2020
Effective Date:
9/15/2020
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

ProAir HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation


Post Date:
9/14/2020
Effective Date:
9/15/2020
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

ProAir RespiClick Aerosol Powder Breath Activated 108 (90 Base) MCG/ACT Inhalation


Post Date:
9/14/2020
Effective Date:
9/15/2020
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

KetoCare STRIP IN VITRO


Post Date:
10/15/2020
Effective Date:
10/15/2020
Type of Change:
Drug removed - Discontinued from marketplace
Reason Changed:
Drug discontinued from marketplace

Ilaris SOLUTION 150 MG/ML Subcutaneous


Post Date:
11/13/2020
Effective Date:
11/15/2020
Type of Change:
Utilization management added
Reason Changed:
Quantity limit updated

Sivextro TABLET 200 MG ORAL


Post Date:
11/13/2020
Effective Date:
11/15/2020
Type of Change:
Utilization management added
Reason Changed:
Prior authorization is required


There are currently no changes for 2021