PacificSource Community Health Plans will be implementing a prior authorization policy for all formulary glucagon-like peptide-1 receptor agonists (GLP-1 RA) medications on the Medicare Part D formulary starting January 01, 2024. This policy will apply to Medicare members currently on or requesting future GLP-1 RAs.
The Centers for Medicare & Medicaid Services (CMS) excludes treatments for certain conditions from Medicare Part D coverage (e.g., cosmetic purposes, weight loss, erectile dysfunction, etc.). PacificSource must follow Medicare rules, therefore, cannot provide drug coverage for these conditions. In addition, with shortages of various drugs on the market, PacificSource prioritizes medication access to members with FDA-indicated diagnoses.
Members will receive a transition fill allowing time for providers to submit the required documentation. After this time members requesting to start or continue these medications will require a prior authorization for coverage. Providers can request authorization for GLP-1 RAs by submitting the member’s most current clinical information, including current level of disease control (e.g., A1c) and treatment history (e.g., prior and current medications), via the InTouch Provider Portal, or Pharmacy Prior Authorization Form.
Please reach out to Customer Service should you have any questions.