This update applies to - Health Net

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PHARMACY UPDATE March 13, 2012 This update applies to all pharmacies in: AZ OR

CA WA

Lines of business: Commercial, Individual & Family plans PHARMACY INQUIRIES ONLY: Claims Processing/ Technical Support Caremark Claims Processing Commercial Pharmacy Help Desk: 1-800-600-0180 *For optimal service, this telephone number is for pharmacy use only.

UPDATE #12-004

PAGE 1 OF 1

Oral Contraceptives April 1 Coverage Change Effective April 1, 2012, the brand name oral contraceptives listed in the table below will no longer be preferred by Health Net. Members who continue to receive the brand-name medications after April 1 may be responsible for a higher copayment or a copayment plus the difference in cost between the brand and generic drugs. The generic drugs listed in the table will be available at the members’ lowest copayment: Brand Name Drug

Preferred Generic Drugs

ORTHO-MICRONOR

• • •

Errin Camila Norethindrone

• • •

Nora-Be Jolivette Heather

ORTHO-NOVUM 7/7/7

• •

Necon 7/7/7 Cyclafem 7/7/7

•

Nortrel 7/7/7

ORTHO-CYCLEN

• •

MonoNessa Sprintec

•

Previfem

• •

TriNessa TriPrevifem

• •

TriSprintec Norgest/Ethi Tab Estradiol

ORTHO TRI-CYCLEN MEMBER INQUIRIES: Refer all member inquiries to the appropriate Customer Service phone number listed on their Health Net ID card.

All Health Net members with recent utilization of these brand name oral contraceptives will be notified of this change by mail. Please inform our members who have been taking these drugs that their prescription will be filled with a generic product and process at their lowest copayment, unless they request the higher-cost brand. These changes do not apply to: • Health Net Medicare Part D plan members For questions regarding the information contained in this update, please contact the Health Net Pharmacy Department at: Region Arizona California Oregon/ Washington

Phone Number 1-800-410-6565 1-800-548-5524, option 3 1-888-802-7001, option 1, then option 4

Health Net® is a registered service mark of Health Net, Inc. All rights reserved.

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