MedicaidPrior AuthMedium impact
23-1177 Medication Trend Updates and Formulary Changes - 4th Quarter 2023
Health Net·CA · Oncology, Rheumatology, Ophthalmology +2 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
CalViva Health updated their 4th quarter 2023 formulary with new biosimilar preferences requiring step therapy, approved second OTC naloxone spray RiVive, and moved three specialty medications (Skyclarys, Lamzede, Syfovre) to different benefit categories with prior authorization requirements.
Action Required
Immediately: Update prior authorization workflows for Lamzede and Syfovre injections under medical benefit. Verify biosimilar step therapy requirements before prescribing branded biologics including Avastin, Remicade, Rituxan, Herceptin, Neupogen, Neulasta, and others - patients must try preferred biosimilars first. Contact CalViva Health at 888-893-1569 for questions and use provider portal for real-time formulary status.