September 28, 2018
As you may remember from our October 2018 Update Bulletin, we recently implemented utilization management on Victoza to ensure that members who were taking it were using it per recommended guidelines. The U.S. Food & Drug Administration (FDA) states that Victoza is to be used only to treat patients who have been diagnosed with type 2 diabetes. Additionally, Victoza is not meant to be used as first-line therapy. We have noticed a trend in members using Victoza who have neither a diagnosis of diabetes, nor are they currently using metformin, according to the previous 12 months of their pharmacy claims history. Our research indicates Victoza is likely being used for weight loss in those cases. The pharmacy benefit for most members does not cover weight loss.
For this reason, we have identified members who have recent prescriptions for Victoza, but who do not have documentation of a type 2 diabetes diagnosis or metformin use in their records. We will soon be sending letters to these members informing them that their doctors must request authorization for them to continue using Victoza. If an authorization request is not received or approved by November 1, 2018, the member will have to pay the full cost of Victoza to continue using it.
Doctors can request Victoza authorization for their patients by calling the Caremark Prior Authorization department at 800-294-5979 or faxing all required documentation to 888-836-0730. If the prior authorization department approves the request, the member’s plan will continue to cover Victoza.