MedicaidPrior AuthMedium impact
22-744 New Medications Added to Prior Authorization Requirements
Health Net·CA·Prior Authorization
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
Health Net California now requires prior authorization for 11 new medications across three effective date tiers, with some requirements already in effect since January 2022. Billing teams must verify prior authorization status before prescribing or administering these specific medications to avoid claim denials.
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 and EMR templates. Staff must verify prior authorization status via Health Net provider portal before prescribing. Update encounter forms to remind providers of PA requirements. Claims will be denied without proper prior authorization.