MedicaidPrior AuthHigh impact
22-708m Find Out What Changed: Reinstatement of Prior Authorizations for Several Drug Classes Under Medi-Cal Rx
Health Net·CA · Family Medicine, Internal Medicine, Pediatrics +2 more·Prior Authorization
Effective date
Sep 16, 2022
We identified it
Jun 20, 2026
Summary
Medi-Cal Rx is reinstating prior authorization requirements for 7 major drug classes including anticoagulants, cardiovascular agents, diuretics, diabetes medications, and cholesterol drugs starting September 16, 2022. Children under 21 are exempt from these new PA requirements.
Action Required
By September 16, 2022: Billing and clinical teams must update workflows to require prior authorization for new prescriptions in 7 drug classes (anticoagulants, cardiovascular agents, coronary vasodilators, diuretics, hypoglycemics, lipotropics, and vitamin B/C products) for Medi-Cal Rx patients in Fresno, Kings, and Madera counties. Update pharmacy and prescribing systems to flag these medications for PA requirements. Exempt patients under 21 years old from PA requirements. Claims without proper PA approval will be denied.