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CommercialPrior AuthHigh impact

Pharmacy prior authorization extension notification

PacificSource Health Plans·Allergy & Immunology, Rheumatology, Dermatology +4 more·Prior Authorization
Effective date
Dec 23, 2025
We identified it
Jan 16, 2026
Days to comply

Summary

PacificSource has extended prior authorization approval date ranges for specific maintenance medications and medical benefit drugs, effective immediately. Commercial members receive 5-year extensions while Medicaid members receive 1-year extensions. Billing teams must verify updated authorization dates in the InTouch for Providers portal to avoid claim denials.

Action Required

Action needed
Immediately: Billing team must log into the ​ InTouch for Providers portal and verify current authorization dates for all extended medications and medical benefit drugs listed in this policy. Update internal authorization tracking systems to reflect new expiration dates. For commercial members, note 5-year extensions from authorization start dates; for Medicaid members, note 1-year extensions. Affected drugs include: Cosentyx, Cimzia, Enbrel, Orencia, Otezla, Rinvoq, Skyrizi, Dupixent, Fasenra, Nucala, Tezspire, Xolair, Adalimumab biosimilars (Adalimumab-ADAZ, Adalimumab-FKJP, Hadlima, Hyrimoz), Ustekinumab biosimilars (Selarsdi, Yesintek), Briviact, Epidiolex, Pulmozyme, Trikafta, Winrevair, Sildenafil 20mg (PAH), Tadalafil 20mg (PAH), Botox, Dysport, Xeomin, Eylea, Eylea HD, Vabysmo, Vyepti, Infliximab biosimilars (Avsola, Inflectra, Renflexi), Tocilizumab biosimilars (Tofidence, Tyenne), Benlysta, Saphnelo, and Rituximab biosimilars (Riabni, Ruxience, Truxima). Front desk and claims processing staff must reference updated authorization dates when verifying eligibility. Failure to update records may result in claim denials for expired authorizations.