20-580sum Summary Update: Stay Up to Date with Medication Trend Updates and Formulary Changes - 3rd Quarter
Date: 07/30/20
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.
For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.
Review changes that improve patient safety and encourage medication adherence
Stay up to date with information about:
- Zero copayment program for Medicare Advantage (MA) members
- Weight-loss drugs Belviq® and Belviq XR® (lorcaserin) withdrawn from the market due to cancer risk
- Changes to the Health Net* commercial Formulary, Medi-Cal Preferred Drug List (PDL) and Medicare Part D Formulary for the third quarter of 2020.
Weight-loss drugs Belviq and Belviq XR withdrawn from the market due to cancer risk
On February 13, 2020, the U.S. Food and Drug Administration (FDA) requested that Eisai Inc., the maker of Belviq and Belviq XR (lorcaserin), withdraw the drug from the U.S. market because a safety clinical trial showed an increased risk of cancer. Eisai Inc. has submitted a request to voluntarily withdraw the drug.
Lorcaserin was first approved by the FDA in 2012 as an add-on therapy to help aid weight loss, along with diet and exercise, in people who were obese or overweight and have weight-related medical problems. Lorcaserin works by increasing feelings of fullness so that less food is eaten. It is available as a tablet (Belviq) and an extended-release tablet (Belviq XR).
When the FDA approved lorcaserin in 2012, the FDA required the drug manufacturer to conduct a clinical trial to evaluate the risk of cardiovascular problems. A range of cancer types was reported, with several different types of cancers occurring more frequently in the lorcaserin group, including pancreatic, colorectal and lung. On January 15, 2020, the FDA announced that Belviq might have links to cancer and concluded that the potential risks of lorcaserin outweigh its benefit. FDA’s analysis found that about 7.7% of Belviq patients had cancer diagnoses, compared with 7.1% of patients who received a placebo.
Health professionals should stop prescribing and dispensing lorcaserin to patients. Inform the patients currently taking lorcaserin of the increased occurrence of cancer seen in the clinical trial, and ask them to stop taking the medicine. They should discuss alternative weight-loss medicines or strategies with their patients.
Zero copayment program for Medicare Advantage members
Health Net continues to encourage member medication adherence and offers zero copayment on some medications to help alleviate barriers to medication adherence and help members better manage their chronic diseases. Most of the medications listed below – in the statins, anti-diabetic agents (not including insulin), angiotensin-converting enzyme inhibitor (ACEI) and angiotensin II receptor blocker (ARB) medication classes – are included on the Select Care tier without copayments for MA members. Members should contact the Health Net Medicare Programs Member Services Department, as listed on the member identification (ID) card, to ensure deductibles have been met.
Zero-Copayment Medications for Medicare Advantage Members | |||
Class | Medication | ||
Lipid management (statins) |
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Anti-diabetic agents
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ACEIs/ARBs
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- SR – sustained release, XR – extended release, HCI – hydrochloride, HCTZ – hydrochlorothiazide
Changes to the commercial Formulary, Medi-Cal PDL and Medicare Part D Formulary
A list of recent changes to the Health Net commercial Formulary, Medi-Cal PDL and Medicare Part D Formulary is available in the complete provider update 20-580, Stay Up to Date with Medication Trend Updates and Formulary Changes – 3rd Quarter 2020. The list contains brand-name prescription medications, status, alternatives, and comments.
To obtain a comprehensive description of the above topics, the complete update, 20-580, is available on the Health Net provider portal in the Provider Library under Updates and Letters > 2020; search for provider update 20-580. You may request a print copy of update 20-580 by contacting the Health Net Provider Communications Department by email at provider.communications@healthnet.com.
Complete lists of the commercial Formularies, Medi-Cal PDLs and Medicare Part D Formularies are available on the Health Net provider website as listed below in the Additional Information section. Once on the website, the lists are viewable under Pharmacy Information.
Pharmacy help line
For more information regarding changes to the Health Net commercial Formulary, Health Net Medi-Cal PDL or Medicare Part DFormulary, contact the applicable pharmacy telephone number listed below:
- Pharmacy Services (commercial): 1-800-548-5524, option #3; fax 1-800-314-6223
- Pharmacy Service Center (Medi-Cal, Medicare and Cal MediConnect): 1-800-867-6564; fax 1-800-977-8226
- Health Net Clinical Pharmacy Line (clinical programs): 1-800-782-2221
Additional information
If you have questions about the information contained in this update, contact the Health Net Provider Services Center by email within 60 days, by telephone or through the Health Net provider website:
Line of Business | Telephone Number | Provider Portal | Email Address |
EnhancedCare PPO (IFP) | 1-844-463-8188 | provider_services@healthnet.com | |
EnhancedCare PPO (SBG) | 1-844-463-8188 | ||
Health Net Employer Group HMO, POS, HSP, PPO, & EPO | 1-800-641-7761 | ||
IFP (CommunityCare HMO, PPO, PureCare HSP, PureCare One EPO) | 1-888-926-2164 | ||
Medicare (individual) | 1-800-929-9224 | ||
Medicare (employer group) | 1-800-929-9224 | ||
Medi-Cal | 1-800-675-6110 | N/A |