CommercialCoverageHigh impact
25-006m Alternate Sites of Care Optimization for Therapeutic Infusions - 1st Quarter 2025
Health Net·CA · Rheumatology, Oncology, Hematology +6 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net has partnered with Coram CVS Specialty Infusion Services as the preferred provider for transitioning therapeutic infusions from hospitals to alternative sites (home, medical offices, or ambulatory infusion suites). This affects a wide range of infusion medications across multiple conditions and requires coordination with Coram for eligible patients when Health Net has financial responsibility.
Action Required
Immediately: For eligible infusion medications listed in the policy, contact Coram CVS Specialty at 866-899-1661 (phone) or 866-843-3221 (fax) to arrange alternative site of care when Health Net has financial responsibility. Billing team must check the Health Net Injectable Medication HCPCS/DOFR Crosswalk to determine financial responsibility before proceeding. If PPG has financial responsibility, work directly with the assigned PPG instead of Coram. Update workflows to identify eligible infusion patients and route them appropriately based on financial responsibility.