MedicaidPrior AuthHigh impact
20-824 Medication Trend Updates and Preferred Drug List Changes - 4th Quarter 2020
Health Net·CA · Oncology, Rheumatology, Gastroenterology +5 more·Prior Authorization
Effective date
Sep 1, 2020
We identified it
Jun 20, 2026
Summary
CalViva Health Medi-Cal updated their preferred drug list for Q4 2020, requiring step therapy with preferred biosimilars before brand-name biologics will be approved. The policy also mandates naloxone co-prescribing for high-risk opioid patients and promotes alternative infusion sites to reduce costs.
Action Required
Immediately: Update prior authorization workflows to require step therapy with preferred biosimilars (Retacrit, Zarxio, Udenyca, Fulphila, Ziextenzo, Inflectra, Renflexis, Ruxience, Mvasi, Zirabev, Ogivri, Trazimera) before approving brand-name products for new Medi-Cal patients. Billing team must verify biosimilar trial/failure or contraindications before submitting prior auth requests for reference products. Providers must offer naloxone prescriptions to patients on ≥90 morphine milligram equivalents daily, concurrent opioid/benzodiazepine therapy, or high overdose risk. Claims may be denied without proper step therapy documentation.