Back to dashboard
CommercialPrior AuthHigh impact

Montana State Based Drug List Change Notification (Commercial)

PacificSource Health Plans·MT · Endocrinology, Cardiology, Pulmonology +6 more·Pharmacy
Effective date
Oct 1, 2025
We identified it
Sep 29, 2025
Days to comply

Summary

PacificSource Montana Commercial plans are removing prior authorization requirements and formulary coverage for 60+ medications effective October 1, 2025, spanning hormone therapies, respiratory, diabetes, and specialty drugs. Billing teams must immediately update systems to stop requiring prior authorizations for these medications and verify patient coverage status, as claims submitted with unnecessary prior auth requests may be denied or delayed.

Action Required

Action needed
By September 30, 2025: Billing team must update PacificSource Montana Commercial formulary configuration in billing software to remove prior authorization requirements for all 60+ listed medications (Androderm, Depo-Estradiol, Estradiol patches/tablets/gels, testosterone products, Alvesco, Brztri, Apidra, Basaglar, insulin products, Alosetron, Dapagliflozin, Deflazacort, Diclofenac, Dihydroergotamine, Fluconazole, Isosorb dinitrate-hydralazine, Ivabradine, Metoclopramide, Naproxen-esomeprazole, Nilutamide, Ofloxacin, Orphenadrine, Paromomycin, Penicillamine, Phenoxybenzamine, Posaconazole, Pyrimethamine, Rufinamide, Sodium phenylbutyrate, Sumatriptan-naproxen, Tadalafil, Trientine, Voriconazole, Acyclovir cream, Brimonidine gel, Dutasteride-Tamsulosin, Fenoprofen, Fesoterodine, Fluoxetine delayed release 90mg, Frovatriptan, Gabapentin, Glutamine powder, Megestrol acetate suspension, Mirabegron, Penciclovir cream, Zolmitriptan nasal spray). Provider staff must be notified to stop requesting prior authorizations for these drugs. Verify with patients that medications are still covered under formulary or removed entirely. Update encounter forms and EHR templates to reflect coverage changes. Failure to remove prior auth requirements will result in processing delays and potential claim denials due to unnecessary authorization requests.
Montana State Based Drug List Change Notification (Commercial) | PacificSource Health Plans | PolicyChanges.app