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California Health & Wellness is no longer a Medi-Cal plan starting January 1, 2024. Regardless of the county you live in, your Medi-Cal service and benefits will not be impacted by the health plan changes since you will be assigned to a new health plan. The county you live in determines your new health plan. Learn more
California Health & Wellness is no longer a Medi-Cal plan starting January 1, 2024. Regardless of the county you live in, your Medi-Cal service and benefits will not be impacted by the health plan changes since you will be assigned to a new health plan. The county you live in determines your new health plan. Learn more

Tamiflu® Prior Authorization Requirements

Date: 10/20/16

The California Health & Wellness P&T Committee added a prior authorization (PA) requirement to Tamiflu with an effective date of October 1, 2016. The PA requirement intends to ensure appropriate use of Tamiflu.

Indications for Tamiflu use per FDA label:

  • Treatment of acute, uncomplicated influenza in patients 2 weeks of age and older who have been symptomatic for no more than 2 days.
  • Influenza prophylaxis in patients 1 year and older.
  • Limitations of Tamiflu use per FDA label:
  • Efficacy not established in patients who begin therapy after 48 hours of symptoms.
  • Not a substitute for annual influenza vaccination.
  • No evidence of efficacy for illness from agents other than influenza viruses types A and B.
  • Consider available information on influenza drug susceptibility patterns and treatment effects when deciding whether to use

California Health & Wellness’ coverage criteria for Tamiflu reflects guidelines published by the Centers for Disease Control (CDC). These guidelines are available at: http://www.cdc.gov/flu/professionals/antivirals/. If you determine that your patient meets these criteria, please fax the completed state-mandated prior authorization form to Envolve Pharmacy Solutions (formerly known as US Script) at 1-866-399-0929 for an expedited review.