MedicaidPrior AuthMedium impact
25-690m Accessing Therapeutic Infant Formula With Prior Authorization
Health Net·CA · Pediatrics, Family Medicine, General Practice·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net's Medi-Cal program now requires prior authorization for ALL therapeutic infant formula for patients up to age 1, including emergency two-week supplies. Standard PA requests take 5 days, urgent requests 72 hours, and emergency supplies are available within 24 hours.
Action Required
Immediately: Billing team must update workflows to require prior authorization for all therapeutic infant formula orders for Medi-Cal patients under age 1. Providers must complete Prescription Drug Prior Authorization or Step Therapy Exception Form and fax to 833-953-3436 with 'Attention: Prior Authorization.' Update EMR templates to document medical necessity. For emergency supplies, explain to caregivers that two-week supply does not guarantee ongoing approval.