Drug Search
This drug search enables you to see if your prescription drug is a covered drug, if your prescription is a generic or brand name drug, and if any special restrictions apply. This drug list is reviewed at least once per month and was last updated on 2/1/2023.
2023 Plan Members:
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.
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.
If you would like a comprehensive printable version of the drug list click the "View/Print Drug List" button on the left. A comprehensive formulary is a complete list of covered drugs.
Note to Providers
Effective January 1, 2019, we will be changing how we cover opioids and other medications considered to be frequently abused or misused. We have made these changes to comply with CMS requirements and to promote the safe use of medications by our members. Please see FAQ documents for more information on how these changes may affect you and your patients.
Quality Assurance
To help ensure the safety of our members, PacificSource Medicare enforces the following Drug Utilization Review and Medication Error Identification and Reduction policy.
Important Information
PacificSource Medicare plans cover both brand name drugs and generic drugs. Generic drugs have the same active ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.
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
Utilization Management
For certain prescription drugs, we have additional requirements for coverage or limits on our coverage. Learn more about utilization management which includes prior authorization, quantity limits, and step therapy.
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2023 Prior Authorization Criteria
Last Uploaded: 2/1/2023
Last Reviewed: 2/1/2023
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2023 Part D Step Therapy Criteria
Last Uploaded: 2/1/2023
Last Reviewed: 2/1/2023
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2023 Part B Step Therapy Criteria
Last Uploaded: 12/7/2022
Last Reviewed: 2/1/2023
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 him or her 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.
The list of covered drugs (formulary) may change at any time. You will receive notice when necessary.