MedicaidAdministrativeMedium impact
24-645m Stay in Compliance With Drug Utilization Review Requirements
Health Net·CA · Family Medicine, Internal Medicine, Pediatrics +2 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
California Health & Wellness Plan providers must implement updated Drug Utilization Review (DUR) programs to monitor concurrent prescribing of opioids with benzodiazepines/antipsychotics and antipsychotic medications for children under 18. The policy supersedes previous guidance and requires updated policies, procedures, and annual reporting to comply with federal SUPPORT Act requirements.
Action Required
Immediately: Review and update policies and procedures for Drug Utilization Review program compliance with APL 23-026 (Revised). Implement concurrent utilization monitoring for opioid/benzodiazepine and opioid/antipsychotic prescriptions. Establish monitoring processes for antipsychotic medications in children under 18 and foster children. Submit updated P&Ps and annual DUR reports to DHCS. Report suspected fraud, waste, and abuse to FWA hotline 866-685-8664 or Special_Investigations_Unit@Centene.com.