MedicaidPrior AuthHigh impact
20-372 Stay Up to Date with Medication Trend Updates and Preferred Drug List Changes - 2nd Quarter 2020
Health Net·CA · Rheumatology, Neurology, Pain Management +3 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
CalViva Health Medi-Cal updated their preferred drug list for Q2 2020, adding new prior authorization requirements for Humira based on indication, implementing FDA safety warnings for gabapentin/pregabalin with respiratory risks, and establishing alternative infusion sites through Coram CVS Specialty for cost savings.
Action Required
Immediately: Update prior authorization workflows for Humira - verify patients with rheumatoid arthritis have tried two preferred medications (Enbrel, Kevzara, Xeljanz) for 3+ months each before requesting PA. For psoriatic arthritis, require three preferred medications tried first. Update drug formulary system with new preferred/non-preferred designations. Train staff on new FDA respiratory depression warnings for gabapentin/pregabalin when combined with opioids or CNS depressants. Contact Peter Tran at (714) 934-3362 to refer infusion patients to alternative sites for potential cost savings.