21-323 Summary Update: Medication Trend Updates and Preferred Drug List Changes - 2nd Quarter 2021
Date: 04/30/21
This information applies to Physicians and Participating Physician Groups (PPGs).
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:
- Patent expiration for commonly used brand-name medications
- HealthNet prefers biosimilars
- Osteoporosis member outreach reports are available
- Changes to the Health Net Formulary, Medi-Cal Preferred Drug List (PDL) and Medicare Part D Formulary for the second quarter of 2021
Patent expiration for commonly used brand-name medications
Patents are granted by the United States Patent and Trademark Office along the development lifeline of a medication. Patents expire 20 years from the date of filing. Many factors can affect the duration of a patent. When a brand-name medication loses its patent, lower-priced generics enter the market.
The Food and Drug Administration- (FDA-) approved generic drugs are made under the same rigorous standards as their brand-name counterparts and are bioequivalent, delivering the same amount of active ingredients into a patient's bloodstream in the same amount of time as their brand-name product. During the upcoming year, it is anticipated that the key medications listed below will be available as generic equivalents.
QUARTER | MEDICATION PATENT EXPIRATIONS FOR 2021 |
|---|---|
1st | Amitiza®, Northera® |
2nd | Absorica®, Banzel® tablet, Chantix®, Perforomist® |
3rd | Bystolic®, Sutent® |
4th | Brovana®, Pradaxa® |
Health Net prefers biosimilars
The FDA approves safe and effective medicines that are highly similar to existing biologic medicines. The FDA regulates biosimilar manufacturing to ensure they scientifically demonstrate safety and effectiveness while showing no clinically meaningful differences. Since biosimilars tend to cost less than their brand name counterparts, they can help lower the overall cost of care for members while still providing quality care.
Since September 1, 2020, Health Net has preferred the following biosimilars over their brand counterparts for commercial and Medi-Cal members. Patients must try and fail (or have contraindications to) the preferred biosimilar before the brand name product will be approved.
REFERENCE PRODUCT (NON-PREFERRED) | PREFERRED BIOSIMILAR(S) |
|---|---|
Epogen®, Procrit® (epoetin alfa) | Retacrit® (epoetin alfa-epbx) |
Neupogen® (filgrastim) | Zarxio® (filgrastim-sndz) |
Neulasta® (peg-filgrastim)* *requires Zarxio® step requirement | ZiextenzoTM (pegfilgrastim-bmez)
|
Remicade® | Inflectra® (infliximab-dyyb) Renflexis® (infliximab-abda) |
Rituxan® | Ruxience® (rituximab-pvvr) |
Avastin® (for non-ophthalmic diagnoses) | MvasiTM (bevacizumab-awwb) ZirabevTM (bevacizumab-bvcr) |
Herceptin® | Ogivri® (trastuzumab-dkst) TrazimeraTM (trastuzumab-qyyp) |
Osteoporosis member outreach reports available
The Management of Post-Menopausal Women with Osteoporotic Fractures Program is a health education outreach and intervention for Health Net Medicare Advantage (MA) female members ages 65 to 85 who have had an osteoporotic fracture in the past three months and have not received a bone-mineral density (BMD) test or are not currently taking prescription medication.
Participating physician groups (PPGs) can access reports with specific Healthcare Effectiveness Data and Information Set (HEDIS®) results to find areas for improvement or best practices. The report provides monthly gap lists for specific measures to find gaps in data and drive member gap closure. These reports are available on the Health Net provider portal as listed below. For technical help on how to gain access to these reports, contact Health Net's Web Support at 866-458-1047.
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 21-323, Medication Trend Updates and Formulary Changes – 2nd Quarter 2021 (PDF). The list contains brand-name prescription medications, status, alternatives, and comments.
You may request a print copy by contacting the Health Net Provider Communications Department by email.
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. 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 D Formulary, contact the applicable pharmacy telephone number below:
- Pharmacy Services (commercial): 800-548-5524, option #3; fax 800-314-6223
- Pharmacy Service Center (Medi-Cal, Medicare and Cal MediConnect): 800-867-6564; fax 800-977-8226
- Health Net Clinical Pharmacy Line (clinical programs): 800-782-222
If you have questions regarding the information contained in this update, contact the applicable Health Net Provider Services Center within 60 days, by telephone or through the Health Net provider website as listed below.
Line of Business | Telephone Number | Provider Portal | Email Address |
|---|---|---|---|
EnhancedCare PPO (IFP) | 1-844-463-8188 |
| |
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 |