24-1276m Prescribe These Medication-Assisted Treatment Drugs Without Prior Authorization
Date: 12/18/24
Delegated PPGs should ensure their systems reflect the bill’s requirements
Effective January 1, 2025, California Assembly Bill (AB) 1842 requires Health Net and delegated participating physician groups (PPGs) to provide coverage without prior authorization (PA), step therapy or utilization review for at least one U.S. Food and Drug Administration-approved drug related to substance use treatment in certain designated categories.
How this affects you
- Prescribers can provide covered drugs that are described below without obtaining PA. Two such physician administered drugs are Sublocade® (buprenorphine) and Vivitrol® (naltrexone). Both drugs can treat opioid use disorder.
- PPGs that are delegated for prior authorization of drugs should ensure they comply with AB 1842. Such PPGs should ensure that their systems allow for coverage with no prior authorization for at least one drug in each of the following categories:
- Medication for the reversal of opioid overdose, including a naloxone product or another opioid antagonist, e.g., Narcan® (naloxone nasal spray).
- Medication for the detoxification or maintenance treatment of a substance use disorder, including a daily oral buprenorphine product, e.g., buprenorphine/naloxone SL or film.
- A long-acting buprenorphine product., e.g., Sublocade (physician administered).
- A long-acting injectable naltrexone product, e.g., Vivitrol (physician administered).
Health Net updates the formulary monthly. Please check the formulary to confirm which covered oral drugs do not require authorization. Access the formulary at provider website > Resources for You > Pharmacy.
Resources
- To access the full bill, go to Assembly Bill No. 1842.
- To access prior authorization lists, visit the Provider Library and select Prior Authorization Requirements in the sidebar. Use one of these two options to access the Provider Library.
Option 1 – Log in on the provider portal
1 Log in to provider portal.
2 Select Provider Library under Quick Links.
Option 2 – Go directly to the Provider Library
Additional information
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by telephone or through the Health Net provider portal.
Behavioral health providers can call 844-966-0298.
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, and Behavioral Health Providers.