CommercialPrior AuthMedium impact
20-371 Stay Up to Date with Medication Trend Updates and Formulary Changes - 2nd Quarter 2020
Health Net·CA · Rheumatology, Gastroenterology, Dermatology +5 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net released multiple updates for Q2 2020 including FDA safety warnings for gabapentin/pregabalin, new prior authorization requirements for Humira across various conditions, formulary changes, and alternative infusion site options. Most significantly, Humira now requires trial of other preferred medications before approval for several conditions.
Action Required
Immediately: Update prior authorization workflows for Humira prescriptions - verify patients have tried required preferred medications (Enbrel, Kevzara, Xeljanz for RA; Enbrel for juvenile arthritis; multiple options for psoriatic arthritis and ankylosing spondylitis) before submitting PA requests. Review formulary changes table and update billing system with new tier placements. Contact Coram CVS at (714) 934-3362 for eligible infusion patients to discuss alternative site options.