PacificSource Health Plans policy updates
Track new and updated PacificSource Health Plans policies impacting reimbursement and clinical operations.
| Policy | Payer | Type | Specialty | Change | Effective |
|---|---|---|---|---|---|
| Diabetic Supplies | Pacificsource | Clinical | Durable Medical Equipment (DME) | Modified | Apr 29, 2012 |
| 2026 PacificSource Health Plans Formulary Exception and Tier Exception Criteria | Pacificsource | Clinical | Pharmacy & Specialty Drugs | Modified | — |
| Weight loss prior authorization criteria for select large groups | Pacificsource | Clinical | Bariatric & Obesity Management | Modified | — |
| 2026 PacificSource Health Plans Prior Authorization Criteria | Pacificsource | Clinical | Pharmacy & Specialty Drugs | Modified | — |
| Medicaid Formulary Exception Criteria | Pacificsource | Clinical | Pharmacy & Specialty Drugs | Modified | — |
| Commercial Quantity Limit Criteria | Pacificsource | Clinical | Pharmacy & Specialty Drugs | Modified | — |
| Site-of-care criteria for provider-administered medications | Pacificsource | Clinical | Pharmacy & Specialty Drugs | Modified | — |
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.
OpenPayer by Trek Health — Policy intelligence for billing and revenue cycle teams.
Coverage data is sourced from publicly available payer medical policy documents and updated as payers publish revisions. Read more about where our data comes from. Always consult the primary payer source for clinical decision-making.