MedicaidPrior AuthMedium impact
23-1490m Stay in Compliance With Drug Utilization Review Requirements That Target Opioids
Health Net·CA · Pain Management, Family Medicine, Internal Medicine +2 more·Prior Authorization
Effective date
Sep 25, 2023
We identified it
Jun 20, 2026
Summary
Health Net has updated drug utilization review requirements for opioid prescriptions following California's APL 23-026, which superseded previous guidance. Healthcare practices must comply with new safety edits including daily morphine milligram equivalent limits, early refill restrictions, and concurrent medication monitoring for Medicaid patients.
Action Required
By December 24, 2023 (90 days from APL 23-026 release): Review current policies and procedures against new DUR requirements. If changes are needed, submit updated P&Ps to MCOD Contract Manager. If no changes are necessary, send email confirmation to MCOD Contract Manager with APL 23-026 title and release date in subject line. Ensure opioid prescriptions comply with: no refills before 75% depletion, maximum 500 MME/daily without prior auth, no duplicates on same date, and maximum 30-day acute or 90-day chronic supply limits.