MedicaidPrior AuthHigh impact
22-707m Find Out What Changed: Reinstatement of Prior Authorizations for Several Drug Classes Under Medi-Cal Rx
Health Net·CA · Cardiology, Endocrinology, Family Medicine +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 multiple drug classes including anticoagulants, cardiovascular agents, diuretics, diabetes medications, and cholesterol drugs effective September 16, 2022. The policy excludes patients 21 and under from these PA requirements and applies to 9 California counties.
Action Required
By September 16, 2022: Billing team must update prior authorization workflows for prescriptions in affected drug classes (anticoagulants, cardiovascular agents, diuretics, diabetes medications, lipotropics) for Medi-Cal Rx patients over age 21 in specified California counties. Verify PA status through provider portal before submitting claims. Claims without approved PA will be denied.