MedicaidPrior AuthHigh impact
25-374m Biosimilar Medications Are Preferred - 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 CalViva Health now requires Medi-Cal members to try preferred biosimilar medications before brand name versions will be approved. This affects multiple biologic drug categories including infliximab, rituximab, and others commonly used in oncology, hematology, and rheumatology.
Action Required
Immediately: Billing team must update prior authorization workflows for biosimilar medications for Medi-Cal members. When prescribing biologic medications, providers must first try preferred biosimilars (Mvasi, Retacrit, Zarxio, Inflectra, Udenyca, Ruxience, Kanjinti, etc.) before requesting brand name versions. Update EMR templates to include biosimilar trial documentation requirements. Failure to document biosimilar trial or contraindication will result in brand name drug denials.