MedicaidCoverageMedium impact
November 2026 Medicaid Drug List Change Notification
PacificSource Health Plans·Pharmacy, Internal Medicine, Rheumatology +1 more·Prior Authorization
Effective date
Nov 15, 2026
We identified it
Oct 13, 2026
Summary
PacificSource Community Solutions Medicaid formulary is removing five medications (Xeljanz, Xeljanz OS, Xeljanz XR, Januvia, Ofev) from coverage and updating quantity limits for Pirfenidone formulations effective November 15, 2026. Billing teams must verify patient coverage and update prior authorization workflows before this date.
Action Required
By November 15, 2026: Billing team must update claims processing and prior authorization systems to reflect the removal of Xeljanz, Xeljanz OS, Xeljanz XR, Januvia, and Ofev from PacificSource Community Solutions Medicaid formulary. Update quantity limit controls for Pirfenidone 267mg to 270/30 and Pirfenidone 801mg to 90/30 in the billing system. Verify affected patient prescriptions and communicate with providers regarding non-covered alternatives. Claims submitted on or after November 15, 2026 for removed medications will be denied unless prior authorization identifies coverage exceptions. Contact PacificSource Pharmacy Services at 888-437-7728 or 541-330-4999 for clarification on any coverage transitions or patient exceptions.