Health net health plan of oregon, inc

Health Net Health Plan of Oregon, Inc. Health Net Life Insurance Company 13221 SW 68th Parkway Tigard, Oregon 97223 Phone 888.802.7001 www.healthnet.com Preferred Drug List (PDL) Changes
SECOND QUARTER 2013 - COMMERCIAL PRODUCTS

Drug Name (generic name)
Tier 1 Additions and Changes
Bactroban®
Treatment of impetigo and other skin infections Adjunctive treatment of partial seizures Limited to 12 tablets per fill and 2 fills per month Treatment of depression, panic disorder, bulimia and obsessive Treatment of depression Removed prior authorization requirement Treatment of fungal infections Removed prior authorization requirement Treatment of high cholesterol. Prevention of stroke and heart attack Removed prior authorization requirement. Limited to 1 tablet per day Tier 2 Additions and Changes
Delzicol®
Treatment of iron toxicity Removed prior authorization requirement Treatment of hepatitis B Removed prior authorization requirement Treatment of human immunodeficiency virus (HIV) infection Removed prior authorization requirement Treatment of fungal infections Removed prior authorization requirement Treatment of infections Removed prior authorization requirement Tier 3 Additions and Changes
Absorica™
Treatment of severe cystic acne Prior authorization required Prevention and treatment of osteoporosis Limited to 4 tablets per month Prevention and treatment of osteoporosis Removed prior authorization requirement. Limited to 1 tablet per month (desloratadine) orally disintegrating Treatment of allergies tablet Crestor® 40mg Treatment of high cholesterol. Prevention of stroke and heart attack Removed prior authorization requirement. Limited to 1 tablet per day Treatment of chronic obstructive pulmonary disease (COPD) Removed prior authorization requirement Treatment of pseudomembranous colitis or Clostridium difficile-associated diarrhea (CDAD) Removed prior authorization requirement Treatment of ulcerative colitis and Crohn’s disease Treatment of iron overload Removed prior authorization requirement Treatment of depression, obsessive compulsive disorder (OCD), bulimia and panic disorder Removed prior authorization requirement. Limited 1 tablet per day Treatment of homozygous familial hypercholesterolemia Prior authorization required Treatment of pneumonia Removed prior authorization requirement. Limited to 10 tablets per fill Adjunctive therapy of seizures Prior authorization required Treatment of heavy menstrual bleeding Up to 30 tablets per month Treatment of attention deficit hyperactivity disorder (ADHD) Treatment of opiate dependence Prior authorization required Treatment of insomnia Removed prior authorization requirement Other Additions and Changes
Berinert®
Treatment of acute attacks of hereditary angiodema (HAE) Prior authorization required Treatment of short bowel syndrome (SBS) Prior authorization required Treatment of homozygous familial hypercholesterolemia Prior authorization required Treatment of advanced renal cell cancer and liver cancer Removed prior authorization requirement Treatment of multiple myeloma Prior authorization required Treatment of leukemia Removed prior authorization requirement Treatment of renal cell cancer, pancreatic neuroendocrine tumor (PNET) and gastrointestinal stromal tumors (GIST) Removed prior authorization requirement Treatment of advanced breast cancer Removed prior authorization requirement
PDL AT WWW.HEALTHNET.COM
Please be sure to visit our websrrent version of our PDL.

FOR QUESTIONS REGARDING THE INFORMATION IN THIS UPDATE, PLEASE
CONTACT THE HEALTH NET PHARMACY DEPARTMENT AT 1-888-802-7001, OPTION 1,
THEN OPTION 4.

Source: http://healthnetpulse.com/broker/files/2013/04/Preffered-Drug-List-OR-WA-Q2-2013.pdf