CommercialPrior AuthMedium impact

24-285m Medication Trend Updates and Formulary Changes - Second Quarter 2024

Q: Who is affected by this change?

This affects Health Net Family Medicine, Internal Medicine, Endocrinology, Neurology, Gastroenterology, General Practice providers in CA on Commercial, Medicaid, Medicare Advantage plans.

Health Net·CA · Family Medicine, Internal Medicine, Endocrinology +3 more·Prior Authorization

Effective date

Not stated

We identified it

Jun 20, 2026

Days to comply

—

Summary

Health Net updated their Q2 2024 formulary with medication changes including new quantity limits and tier changes for diabetes medications, plus FDA warnings about serious drug reactions for antiseizure medicines. Several medications moved to non-formulary status or changed tiers requiring prior authorization.

Action Required

Action needed

Immediately: Billing team must verify current formulary status for Trulance, saxagliptin (Onglyza), and saxagliptin-metformin (Kombiglyze XR) in billing system. Update prior authorization requirements for non-formulary medications. Providers should be alerted about FDA warnings for levetiracetam (Keppra) and clobazam (Onfi) causing DRESS syndrome. Contact Health Net pharmacy help lines for specific formulary questions using provided phone numbers.

Related policy hubs

Health Net policies CA policy changes Family Medicine Internal Medicine Endocrinology Neurology Gastroenterology General Practice