CommercialPrior AuthHigh impact
25-376m Health Net Prefers Biosimilar Medications - 2nd Quarter
Health Net·CA · Oncology, Hematology, Rheumatology +1 more·Prior Authorization
Effective date
Sep 1, 2020
We identified it
Jun 20, 2026
Summary
Health Net now requires patients to try preferred biosimilar medications before covering brand name versions for oncology, rheumatology, and other biologic drugs. Prior authorization is required for brand name drugs unless the patient has failed or has contraindications to the preferred biosimilar alternatives.
Action Required
Immediately: Update prior authorization workflows to ensure patients try preferred biosimilar medications (Mvasi, Zirabev, Retacrit, Zarxio, Nivestym, Inflectra, Renflexis, Avsola, Udenyca, Nyvepria, Ruxience, Truxima, Kanjinti, Ogivri, Trazimera) before requesting brand name biologics. Clinical staff must document trial and failure or contraindications to biosimilars when requesting prior auth for reference products. Review Health Net's Drug Coverage Policies for complete prior authorization guidelines.