MedicaidPrior AuthMedium impact
23-1465 Protect Your Adult Patients and Patients Who Are Pregnant Against RSV Illness
Health Net·CA · Family Medicine, Internal Medicine, OB-GYN +1 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
CalViva Health now covers RSV vaccines for adults 60+ without prior authorization and for pregnant women (32-36 weeks) with prior authorization required. Vaccines are covered as preventive care at no out-of-pocket cost and available through retail pharmacies.
Action Required
Immediately: Update prior authorization workflows to require approval for RSV vaccines (Abrysvo) for pregnant patients between 32-36 weeks gestation. Verify patient eligibility through CalViva Health provider portal before administering. No prior auth needed for patients 60+. Contact CalViva Health at 888-893-1569 for questions.