Health Net News Now

Talking Trend

New Weight Loss Drugs Surge in Popularity

Obesity affects roughly 42% of U.S. adults, according to the Centers for Disease Control and Prevention (CDC). And about two-thirds of Americans (65%) say will power alone usually isn’t enough for most people who are trying to lose weight and keep it off, according to a new Pew Research Center survey. Put those two facts together, and it should come as no surprise that a new class of drugs to help people lose weight – including Ozempic, Wegovy and similar medications – has soared in popularity. In the Center survey, about three-quarters of Americans say they have heard or read at least a little about these drugs.

Unfortunately, supply has not kept up with the soaring popularity. Some people have resorted to ordering the drugs online or through compounding pharmacies, both of which can be a gamble. In other countries, fake versions have led to hospitalizations.¹

CNN Medical Correspondent Meg Tirrell advises, “It’s important to consult with a trusted health-care provider if you’re considering these medicines — like all prescription drugs, they have powerful effects,” Tirrell said. “A trusted health-care provider can work with you to assess which options are best for you and to monitor safety, efficacy and how well you tolerate the medicines.”

Health Net’s Policy on Weight Loss Prescription Coverage - Weight Loss Drugs Require Prior Approval

All weight loss drugs require prior approval based on Health Net’s drug use guidelines. For approval, Health Net Medical Necessity criteria must be met based on:

• BMI (Body Mass Index)
  
• Documentation of member’s baseline and current height and body weight within the last 30 days;
• Other medical issues
• Documentation supporting member’s participation in a Health Net approved weight loss program (e.g., Weight Watchers) or other weight loss programs recommended by the prescriber that involves a reduced calorie diet, increased physical activity, and behavioral modification.
  

To request prior authorization, the prescriber must complete and fax a Prior Authorization form to: 866-399-0929.

To access Pharmacy Prior Authorization Guidelines, please refer to: Health Net Commercial Drug Coverage Policies | Health Net.

To access the List of Covered Drugs based on your group size, please refer to: Employer Group Drug List | Health Net.

For questions, contact your Health Net Account Representative.

¹ CNN Health

Industry News

States Imposing Tighter Prior Authorization Rules On Health Insurance Companies

Modern Healthcare (8/27, McAuliff) reports, “While Congress appears stalled with its legislative proposals to streamline prior authorizations, many states have surged ahead and imposed tighter rules on health insurance companies.” A National Conference of State Legislatures database shows that “23 states enacted more than 43 bills related to prior authorization in the last few years, with 18 enacted so far in 2024 alone.”

While insurers including UnitedHealth Group and Cigna Healthcare “have eased prior authorization requirements for certain services, complaints from providers and patients continue.”

The American Medical Association, “which opposes restrictive prior authorization polices, reported last week that 10 states –Colorado, Illinois, Maine, Maryland, Minnesota, Mississippi, Oklahoma, Vermont, Virginia and Wyoming – have approved broad prior authorization bills it supports.”

The California Legislature has introduced SB 598, currently awaiting Committee Review. On or after January 1, 2026, this bill would prohibit a health care service plan or health insurer from requiring a contracted health professional to complete or obtain a prior authorization for any covered health care services if the plan or insurer approved or would have approved not less than 90% of the prior authorization requests they submitted in the most recent completed one-year contracted period.

Health Net News

California Brokers - Get Expert Insights to Sell 2025 IFP Business

We’re pleased to invite you to our next Health Net IFP Virtual Broker Roadshow on 2025 Individual and Family Plan’s business selling solutions.

Join us and set the tone for your 2025 sales success! We’ll cover timely topics delivered by our Sales and Leadership team including:

To qualify:

SBG: The top 8 Brokers will secure a spot. Minimum 250 members to qualify. (contest runs from June 2024–January 2025 effective dates) ¹

LGB: The top 8 Brokers will secure a spot. Minimum 300 members to qualify. (contest runs from June 2024–January 2025 effective dates) ¹

IFP: The top 8 Brokers will secure a spot. Minimum 250 members to qualify. (contest runs for the entire month of January 2025) ²

For more information, contact your Health Net Sales Representative.

¹ Top-selling brokers are those who sell to the most members during the contest period June 1, 2024 through January 31, 2025. Small Group sales through Cal Choice do not qualify.

² Top-selling brokers are those who sell the most January 2025 members.

In the Community

L.A. Care and Health Net Commit $90 Millionto Support Those Experiencing Homelessness

L.A. Care and Health Net have announced a $90 million commitment over five years to ensure people who are experiencing homelessness get the preventive and coordinated, whole-person care they need, in addition to access to specialty care and other medically necessary services. The two complementary programs being established have the potential to assist more than 85,000 Angelenos:

• L.A. County Field Medicine Program (Field Medicine Program), and
• Skid Row Care Collaborative

The Field Medicine Program is a $60 million program designed to deliver preventive and urgent health care, chronic disease management, social services, primary care and access to a true medical home to members in their lived environments — on the streets, in tent encampments, in shelters and in interim housing sites specifically to address these drivers of high mortality among people experiencing homelessness.

The second program, the Skid Row Care Collaborative, is a core component of the Field Medicine Program. It is designed to accommodate the unique needs of Skid Row as a neighborhood with a high density of both people experiencing homelessness, as well as support for the established providers to care for them. The Skid Row Care Collaborative includes $30 million of funding for enhanced services and additional facilities on Skid Row, including $10 million in funding to launch the Los Angeles County Department of Health Services Crocker Street Campus.

The two new programs align with the health plans' shared commitment to advancing health equity, which means ensuring that everyone, regardless of housing status or social barriers, has a fair and equal opportunity to be as healthy as possible.

Wellness

New Member Cancer Screening, Prevention and Treatment Webpage Now Available!

JUST FOR FUN

Healthy Halloween Treats That Won’t Disappoint

While indulging in the occasional candy treat is okay, according to Northwest Family Clinics , the average American child consumes a startling amount of sugar annually.  Excessive sugar intake can lead to various health issues, including obesity, tooth decay, and an increased risk of chronic diseases like diabetes. Therefore, it's essential to strike a balance between enjoying the festivities and maintaining a healthy lifestyle. (Ask if any of the children have dairy or nut allergies if your treats include these ingredients.)

Halloween Treat Alternatives

• Fruit Snacks and Fruit Leather: Instead of sugary candy, opt for fruit snacks and fruit leather made from real fruit without added sugars. These treats offer a natural sweet taste without the added sugars and artificial flavors found in many candies.
• Dark Chocolate: If you want to satisfy a chocolate craving, choose dark chocolate with a high cocoa content (70% or more). Dark chocolate contains less sugar than milk chocolate and provides antioxidants that can benefit overall health.
• Trail Mix: Buy small pre-made sealed packs of trail mix with a variety of nuts, seeds, dried fruits, and a hint of dark chocolate chips. It's a balanced and energy-packed snack that can keep kids fueled during their Halloween adventures.
• Mini Popcorn Bags: Small, individually portioned and sealed bags of air-popped or lightly seasoned popcorn make for a tasty and satisfying treat without excessive calories or sugar.
• Non-Food Treats: Consider handing out non-food items like stickers, temporary tattoos, mini toys, or glow sticks. These alternatives can be just as exciting for kids and are free from added sugars.
• Yogurt-Covered Raisins or Pretzels: These snacks offer a combination of sweet and salty flavors while containing less sugar than traditional candy-coated treats.
• Sugar-Free Gum: Sugar-free gum can be an excellent alternative, as it can help satisfy the desire for something sweet without the harmful effects of sugar.
• Fruit Cups: Individual servings of fresh fruit cups with no added  sugars are a healthier option for Halloween treats.
• Mini Cheese Packs: Cheese sticks or small cheese portions can be a unique and satisfying option that provides protein and calcium.