24-285m Medication Trend Updates and Formulary Changes - Second Quarter 2024
Date: 03/29/24
Review formulary changes and medication safety issues
Stay up to date with information about:
- FDA warns of rare but serious drug reaction to antiseizure medicines (clobazam, levetiracetam)
- Changes to the Health Net commercial Formulary, Medi-Cal Preferred Drug List (PDL) and Medicare Part D Formulary for the second quarter of 2024.
FDA warns of rare but serious drug reaction to antiseizure medicines (clobazam, levetiracetam)
On November 28, the Food and Drug Administration (FDA) issued a safety alert about levetiracetam and clobazam causing a rare but serious reaction called drug reaction with eosinophilia and systemic symptoms (DRESS), which can be life threatening if not diagnosed and treated quickly.
Levetiracetam is marketed under the brand names Keppra®, Keppra XR® and Spritam® for the treatment of partial-onset seizures, myoclonic seizures, or tonic-clonic seizures. Clobazam is the active ingredient in Onfi® and Sympazan® and is used to treat Lennox-Gastaut syndrome.
The drug reaction known as DRESS is a rare and severe drug allergy. Symptoms can include fever, rash, facial swelling, enlarged lymph nodes and kidney or liver injury. Patients with DRESS have a large number of abnormal eosinophils.
A search of the FDA Adverse Event Reporting System and the medical literature through March 2023 identified 32 serious cases of DRESS worldwide that were associated with levetiracetam and 10 patients treated with clobazam. Two patients treated with levetiracetam died. Most patients in these cases were hospitalized, and, in the majority of cases for which the FDA had information, DRESS symptoms improved when the medicines were discontinued.
As a result of these cases, the FDA announced that warnings about the risk of DRESS will be added to the prescribing information and patient medication guides for these medicines. Patients should be advised of the signs and symptoms of DRESS and be told to stop taking the medicine and seek immediate medical attention if DRESS is suspected during treatment with levetiracetam or clobazam.
Changes to the Commercial Formulary, Medi-Cal PDL and Medicare Part D Formulary/Drug benefit
The Health Net Pharmacy and Therapeutics (P&T) Committee includes practicing physicians, pharmacists and other health care professionals. Each quarter, the P&T Committee reviews medications on the Formulary for commercial members, the PDL for Medi-Cal members, and the Medicare Part D Formulary for Medicare members to determine which medications remain on the same tier and which are moved. A table below listing some recent changes. The list contains brand-name prescription medications, status, other medication choices, and comments for the second quarter of 2024.
The complete lists of the commercial Formularies, Medi-Cal PDLs and Medicare Part D Formularies are available on the Health Net provider portal.
Pharmacy help line
For more information regarding changes to the Health Net Commercial Formulary or Health Net Medi-Cal Preferred Drug List, or Medicare Part D Formulary, contact the proper pharmacy phone numbers listed below:
Product | Phone number | Fax number |
|---|---|---|
Pharmacy Benefit (Medi-Cal Rx) | 800-869-4325 | |
Medical Benefit Drugs (Medi-Cal) | 833-953-3436 | |
Commercial Pharmacy Services | 800-548-5524, option #3 | 866-399-0929 |
Medicare Pharmacy Service Center | 800-977-8226 |
Health Net Commercial Formulary, Medi-Cal PDL and Medicare Part D Formulary Changes
Medication | Status | Health Net Formulary Alternative(s) | Comments | ||||
|---|---|---|---|---|---|---|---|
Commercial Tier 3 plan (Tier 4 plan) | Medicare Part D (6-Tier preferred)1 | Medi-Cal | Commercial | Medicare | Medi-Cal | ||
Oral preparation
Trulance® (plecanatide) tablet | NF (QL) | NF | Carve out to state | lubiprostone (Amitiza®) | lubiprostone (Amitiza) | N/A | Nonpreferred for commercial line of business Quantity limit (QL) is 1 tablet daily |
saxagliptin (Onglyza®) tablet | Tier 1 (QL) | NF | Carve out to state | N/A | Januvia®, Janumet® | N/A | Generic preferred for commercial line of business Quantity limit (QL) is 1 tablet daily |
saxagliptin-metformin (Kombiglyze® XR) tablet | Tier 1 (QL) | NF | Carve out to state | N/A | Januvia, Janumet | N/A | Generic preferred for commercial line of business Quantity limit (QL) is 1 tablet daily |
- Note: The information above is subject to change. Please refer to the provider portal, for the most up-to-date formulary status.
1Medicare Part D: Health Net Gold Select (HMO), Health Net Healthy Heart (HMO), Health Net Jade (HMO C-SNP), Health Net Ruby (HMO), Health Net Ruby Select (HMO), Health Net Sapphire (HMO), Health Net Violet 1 (PPO), Health Net Violet 2 (PPO), Health Net Violet 3 (PPO), Health Net Violet 4 (PPO)
Information above is subject to change. Please use Healthnet or Wellcare website for the most up-to-date formulary status
2Prior authorization (PA) is required to verify that the member is eligible and satisfies clinical protocols to ensure appropriate use of the medication.
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.
Additional information
If you have questions regarding the information contained in this update, contact the applicable Health Net Provider Services Center at:
Line of Business | Phone number | Email address |
|---|---|---|
IFP Ambetter PPO | ||
IFP Ambetter HMO | ||
Health Net Employer Group HMO, POS, & PPO | ||
Medicare (Individual & Employer Group) | ||
Medi-Cal | N/A |
This information applies to Physicians and Participating Physician Groups (PPGs).
For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, Molina, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.