CommercialPrior AuthHigh impact
20-823 Medication Trend Updates and Preferred Drug List Changes - 4th Quarter 2020
Health Net·CA · Oncology, Hematology, Rheumatology +5 more·Prior Authorization
Effective date
Sep 1, 2020
We identified it
Jun 20, 2026
Summary
Health Net updated its 4th quarter 2020 medication policies requiring providers to co-prescribe naloxone for high-risk opioid patients, mandating step therapy for biosimilar drugs before brand-name biologics, and establishing preferred alternative infusion sites. New prior authorization requirements apply for brand biologics when biosimilars are available.
Action Required
Immediately: Update prior authorization workflows to require step therapy with preferred biosimilars (Retacrit, Zarxio, Udenyca, Fulphila, ZiextezoTM, Inflectra, Renflexis, Ruxience, MvasiTM, ZirabevTM, Ogivri, TrazimeraTM) before approving brand biologics. Providers must offer naloxone prescriptions to patients on ≥90 morphine milligram equivalents daily, concurrent opioid/benzodiazepine therapy, or high overdose risk. Contact Coram CVS Specialty at (714) 934-3362 for infusion site alternatives. Claims for brand biologics will be denied without documented biosimilar step therapy failure.