Drug search
Here's where to learn which drugs your plan covers. You can also see whether a drug is brand-name or generic and learn of any restrictions for its use.
Drug lists are reviewed monthly. Latest update: 12/1/2024
Important Message About What You Pay for Vaccines – Our plan covers most Part D vaccines at no cost to you, even if you haven’t paid your deductible. We follow the ACIP vaccine recommendations for Part D vaccine coverage. For more information on which vaccines are recommended for you, visit the CDC Vaccine-Specific Recommendations site.
Paxlovid™ at reduced or no cost – With Pfizer's PAXCESS™ Patient Support Program, most members can get big savings on this COVID-19 drug. To learn more or enroll, visit the PAXCESS site.
Important Message About What You Pay for Insulin – You won't pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it's on, even if you haven't paid your deductible.
For a complete, printable drug list, choose "View/Print Drug List" at left.
Home delivery
Save money with CVS Caremark mail order.
- $0 copay on preferred generic (Tier 1) and select care drugs (Tier 6). Does not apply to PERS plan.
- 90-day supply for 60-day cost for generic (Tier 2) and preferred brand (Tier 3). Does not apply to PERS plan.
- Free shipping and optional auto-refills
To have your prescriptions filled at our Preferred mail-order pharmacy, please use the mail-order form, register online , or call.
CVS Caremark Mail-Order ServicesRegister online at: www.CareMark.com
Toll-Free: 866-362-4009
TTY/TDD: 711
Pay $0 for many popular prescriptions
Select Care (Tier 6) drugs are included in your prescription plan, and you'll pay $0 for up to a 90-day supply at preferred pharmacies. These drugs treat conditions related to blood pressure, cholesterol, diabetes, and more.
Note: Does not apply to PERS plan. See PERS drug list at left.
About generics
PacificSource Medicare plans cover both brand and generic drugs. Generic drugs have the same active ingredient as a brand-name drug. Generics usually cost less and are determined by the Food and Drug Administration (FDA) to be as safe and effective as their brand-name counterparts.
Utilization management
For certain prescriptions there are additional requirements or limits. Learn more about utilization management, including prior authorization, quantity limits, and step therapy:
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2024 Prior Authorization Criteria
Last Uploaded: 12/1/2024
Last Reviewed: 12/1/2024 -
2025 Prior Authorization Criteria
Last Uploaded: 12/16/2024
Last Reviewed: 12/1/2024
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2024 Part D Step Therapy Criteria
Last Uploaded: 12/1/2024
Last Reviewed: 12/1/2024 -
2025 Part D Step Therapy Criteria
Last Uploaded: 11/27/2024
Last Reviewed: 12/1/2024
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2024 Part B Step Therapy Criteria
Last Uploaded: 12/11/2024
Last Reviewed: 12/1/2024 -
2025 Part B Step Therapy Criteria
Last Uploaded: 12/11/2024
Last Reviewed: 12/1/2024
Your rights
You and your doctor have the right to request an exception to the plan’s formulary or coverage criteria. If your drug is not included in this drug search, you should first contact Customer Service and confirm that your drug is not covered. If you learn that your PacificSource Medicare plan does not cover your drug, you have two options:
- You can ask Customer Service for a list of similar drugs that are covered by PacificSource Medicare. When you receive the list, show it to your doctor and ask them to prescribe a similar drug that is covered by PacificSource Medicare.
- If you would like to request an exception, please contact the PacificSource Medicare Customer Service Department.
Quality assurance
To help ensure the safety of our members, PacificSource Medicare has adopted a Drug Utilization Review and Medication Error Identification and Reduction policy.
The list of covered drugs (formulary) may change at any time. You will receive notice when necessary. Other pharmacies are available in our network.