MedicaidPrior AuthMedium impact
22-747 New Medications Added to Prior Authorization Requirements
Health Net·CA·Prior Authorization
Effective date
Jul 1, 2022
We identified it
Jun 20, 2026
Summary
Health Net is requiring prior authorization for 11 new medications effective at different dates in 2022, with the most recent batch (6 medications including EnjaymoTM, Kimmtrak®, Leqvio®, Tezspire®, Vabysmo®, Vyvgart®) taking effect July 1, 2022. This applies to Medi-Cal providers in Fresno, Kings and Madera counties only.
Action Required
Immediately: Billing team must update prior authorization requirements for 11 new medications (RylazeTM, SaphneloTM, FyarroTM, Ryplazim®, SusvimoTM, TivdakTM, Xipere®, EnjaymoTM, Kimmtrak®, Leqvio®, Tezspire®, Vabysmo®, Vyvgart®) in billing system for Medi-Cal patients in Fresno, Kings and Madera counties. Check Health Net provider portal for current PA requirements and update encounter forms to alert providers. Claims will be denied without proper prior authorization.