News and updates

Currently, continuous glucose monitors are covered under both durable medical equipment (DME) and pharmacy benefits. Effective January 1, 2024, we are transitioning all therapeutic CGMs to the...

Updates on Existing Criteria January 2024. The following changes to criteria are effective January 22, 2024: Prior Authorization Criteria – Clinical...

Certain codes will require prior authorization for Oregon Medicaid members.

Beginning November 13, 2023, PacificSource will use different criteria for level-of-care decisions for mental health treatment (including inpatient, residential, partial...

Clarification and update. See frequently asked questions below. Effective January 1, 2024, PacificSource will begin completing utilization management reviews for members who have...

Updates on Existing Criteria December 2023. The following changes to criteria are effective December 22, 2023: Prior Authorization Criteria – Clinical Updates...

We have recently updated our prior authorization list and coverage policies. This change is effective for dates of service on or after November...

New prior authorization requirements for providers regarding certain behavioral health services

Here’s what you need to know: Coverage of Humira (adalimumab) through PacificSource Community Solutions will change to other, biosimilar formulations. Will I still be able to prescribe Humira?...

PacificSource Community Solutions (Medicaid) allows a 20-day skilled nursing facility (SNF) stay for individuals who qualify for skilled care. Prior authorization is not required for admission to a...