MedicaidPrior AuthHigh impact
25-375m Biosimilar Medications Are Preferred - 2nd Quarter
Health Net·CA · Oncology, Hematology, Rheumatology +2 more·Prior Authorization
Effective date
Sep 1, 2020
We identified it
Jun 20, 2026
Summary
Health Net now requires Medi-Cal members in Imperial County to try preferred biosimilar medications before brand name biologics will be approved. This affects prior authorization requirements for medications like infliximab, rituximab, trastuzumab, and other biologic agents commonly used in oncology and specialty care.
Action Required
Immediately: Billing and clinical teams must verify preferred biosimilar requirements before prescribing biologic medications for Health Net Medi-Cal members in Imperial County. Update prior authorization workflows to ensure preferred biosimilars (Mvasi, Retacrit, Zarxio, Inflectra, Udenyca, Ruxience, Kanjinti, etc.) are tried first. Check Drug Coverage Policies on provider website for complete prior authorization guidelines. Claims for brand name biologics will be denied without documentation of biosimilar failure or contraindication.