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 10/3/2018.
If you would like a comprehensive printable version of the drug list click the "Print Drug List" button on the left. A comprehensive formulary is a complete list of covered drugs.
Note to Providers
Effective November 1, 2014, we are requesting that medication authorizations be submitted online via the InTouch portal (link above). This transition is being implemented to allow faster turnaround on medication authorization requests.
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
The list of covered drugs (formulary) may change at any time. You will receive notice when necessary.
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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2018 Prior Authorization Criteria
Last Uploaded: 10/3/2018
Last Reviewed: 10/1/2018 -
2019 Prior Authorization Criteria
Last Uploaded: 10/17/2018
Last Reviewed: 10/1/2018
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2018 Step Therapy Criteria
Last Uploaded: 10/3/2018
Last Reviewed: 10/1/2018 -
2019 Step Therapy Criteria
Last Uploaded: 10/17/2018
Last Reviewed: 10/1/2018
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.