21-473 Medication Trend Updates and Preferred Drug List Changes - 3rd Quarter 2021
Date: 07/09/21
This information applies to Physicians and Participating Physician Groups (PPGs).
This information applies to Medi-Cal in Fresno, Kings and Madera counties.
Review changes that improve patient safety and encourage medication adherence
Stay up-to-date with information about:
- Changes to the CalViva Health Medi-Cal Preferred Drug List (formulary) for the third quarter of 2021
Preferred Drug List changes
The Pharmacy and Therapeutics (P&T) Committee, which includes practicing physicians, pharmacists and other health care professionals, reviews medications on the CalViva Health Medi-Cal Preferred Drug List each quarter to determine medications to stay on or be moved to a different status. A list of some recent changes is provided in the table below. The list contains brand-name prescription medications, status, other medication choices, and comments for the third quarter of 2021.
A complete CalViva Health Medi-Cal Preferred Drug List is available on the provider website at provider.healthnet.com under Pharmacy Information.
Medication | Status | Formulary alternative(s) | Comments |
|---|---|---|---|
Accrufer™ (ferric maltol) capsule | NF* | ferrous fumarate, ferrous gluconate, ferrous sulfate, polysaccharide iron complex | Treatment of iron deficiency in adults
|
Evrysdi™ (risdiplam) oral solution | NF* | Spinraza® *,** | Treatment of spinal muscular atrophy (SMA) in patients ages 2 months and older |
Orladeyo™ (berotralstat) capsule | NF* | Cinryze*,** | Prophylaxis to prevent attacks of hereditary angioedema (HAE) in adults and pediatric patients ages 12 and older |
Zokinvy™ (lonafarnib) capsule | NF* |
| In patients ages 12 months and older with a body surface area of 0.39 m2 and above:
|
Medication | Status | Formulary alternative(s) | Comments |
|---|---|---|---|
Bronchitol® (mannitol) inhaler | NF* | hypertonic saline (HyperSal®, NebuSal®), Pulmozyme** | Add-on maintenance therapy to improve pulmonary function in adult patients ages 18 and older with cystic fibrosis (CF) |
Medication | Status | Formulary alternative(s) | Comments |
|---|---|---|---|
Amondys 45® (casimersen) single-dose vial | Medical benefit* |
| Treatment of Duchenne muscular dystrophy (DMD) in patients who have a confirmed mutation of the DMD gene that is amenable to exon 45 skipping |
Breyanzi® (lisocabtagene maraleucel) single-dose vial | Medical benefit* | Kymriah™*,** | Treatment of adult patients with relapsed or refractory large B-cell lymphoma (LBCL) after two or more lines of systemic therapy, including diffuse large B-cell lymphoma (DLBCL) not otherwise specified (including DLBCL arising from indolent lymphoma), high-grade B-cell lymphoma, primary mediastinal large B-cell lymphoma, and follicular lymphoma grade 3B |
Enspryng™ (satralizumab-mwge) single-dose prefilled syringe | Medical benefit* | Soliris® *,** | Treatment of neuromyelitis optica spectrum disorder (NMOSD) in adult patients who are anti-aquaporin-4 (AQP4) antibody positive |
Evkeeza™ (evinacumab-dgnb) single-dose vial | Medical benefit* | atorvastatin, fluvastatin, pravastatin, rosuvastatin, simvastatin, simvastatin/ezetimibe | Adjunct to other low density lipoprotein-cholesterol (LDL-C) lowering medications for the treatment of adult and pediatric patients ages 12 and older with homozygous familial hypercholesterolemia (HoFH) |
Imcivree™ (setmelanotide) multi-dose vial | Medical benefit* |
| Chronic weight management in adult and pediatric patients ages 6 and older with obesity due to proopiomelanocortin (POMC), proprotein convertase subtilisin/kexin type 1 (PCSK1), or leptin receptor (LEPR) deficiency confirmed by genetic testing demonstrating variants in POMC, PCSK1, or LEPR genes that are interpreted as pathogenic, likely pathogenic, or of uncertain significance (VUS) |
Oxlumo™ (lumasiran) single-dose vial | Medical benefit* | pyridoxine | Treatment of primary hyperoxaluria type 1 (PH1) to lower urinary oxalate levels in pediatric and adult patients |
*Prior authorization (PA) is required to verify member eligibility and that the member satisfies clinical protocols to ensure appropriate use of the medication.
**CCS = California Children’s Services: refer to The DHCS website for the local telephone number to determine member’s coverage eligibility.
***Prior authorization (PA) for new start only is required to verify member eligibility and that the member satisfies clinical protocols to ensure appropriate use of the medication.
- F indicates formulary.
- NF indicates nonformulary; NP indicates nonpreferred. These medications require member-specific medical reasons why formulary medications cannot be considered. Requests are reviewed via Health Net's prior authorization process.
- SP indicates specialty tier.
- AL indicated age limit.
- EST indicated electronic step therapy.
- IR indicated immediate release
- ER indicated extended release
Additional information
Providers are encouraged to access the provider portal online at provider.healthnet.com for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact CalViva Health at 888-893-1569.