MedicaidPrior AuthMedium impact
[California] Prior authorization updates
Anthem BCBS·CA · Pharmacy·Provider Bulletin
Effective date
Sep 1, 2026
We identified it
May 9, 2026
Summary
Effective September 1, 2026, four specialty pharmacy drugs billed under medical benefits now require prior authorization for California Medicaid (Medi-Cal) patients: Fesilty (fibrinogen), Loargys (pegzilarginase), Vykoura (leucovorin calcium), and Yuviwel (navepegritide). Patients currently receiving these medications without prior authorization will require prior auth approval for continued treatment going forward. National Drug Codes (NDCs) must be included on medical claims for processing.
Action Required
By August 31, 2026: Billing team must update prior authorization protocols to require approval for all medical claims containing Fesilty (fibrinogen, human-chmt), Loargys (pegzilarginase-nbln), Vykoura (leucovorin calcium), and Yuviwel (navepegritide) for California Medicaid patients. Clinical Criteria resources are available at the payer's Clinical Criteria website—team should review specific approval criteria for each drug. Ensure all claims for these medications include the National Drug Code (NDC). Providers should be notified to initiate prior authorization requests before prescribing or continuing these medications for Medi-Cal beneficiaries. Access Availity Chat with Payer for questions during business hours. Claims submitted without prior authorization will be subject to denial.