MedicaidAdministrativeMedium impact
24-644m 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
Health Net California updated drug utilization review (DUR) requirements to comply with federal SUPPORT Act provisions, requiring enhanced monitoring of concurrent opioid/benzodiazepine/antipsychotic prescriptions and antipsychotic medications for children under 18. The policy also establishes fraud, waste and abuse reporting requirements for controlled substances.
Action Required
Immediately: Review current drug utilization review processes to ensure compliance with concurrent medication monitoring requirements. Establish procedures for retrospective claims review of members prescribed concurrent opioids/benzodiazepines or opioids/antipsychotics. Implement monitoring processes for all psychiatric medications (antipsychotics, mood stabilizers, antidepressants) for patients under 18 and foster children. Report suspected fraud, waste or abuse to Health Net's FWA hotline at 866-685-8664 or Special_Investigations_Unit@Centene.com.