CommercialCoverageMedium impact
24-459m Alternate Sites of Care Optimization for Therapeutic Infusions - 2nd Quarter 2024
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 therapeutic infusions, allowing members to receive infusions at home or ambulatory infusion suites instead of hospitals. The policy covers a comprehensive list of specialty medications for various conditions including autoimmune disorders, immune deficiencies, and rare diseases for Commercial and Exchange members.
Action Required
Immediately: Billing team must identify patients receiving therapeutic infusions listed in the policy and coordinate with Coram CVS Specialty (866-899-1661) for home infusion services when Health Net has financial responsibility. Check the Health Net Injectable Medication HCPCS/DOFR Crosswalk to determine financial responsibility between Health Net and PPGs. For PPG financial responsibility cases, work directly with the member's assigned PPG using their contracted home health vendor.