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CommercialPrior AuthMedium impact

22-338 Medication Trend Updates and Formulary Changes - 1st Quarter 2022

Health Net·CA · Gastroenterology, Pediatrics, Pain Management +1 more·Prior Authorization
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply
—

Summary

Health Net updated their formulary for Q1 2022, adding two new medications (Bylvay and Livmarli) that require prior authorization for new starts only. The FDA also issued a warning about dental problems associated with orally dissolving buprenorphine.

Action Required

Action needed
Immediately: Update prior authorization workflow to require PA for new starts of Bylvay (odevixibat) and Livmarli (maralixibat) under medical benefit for Health Net Commercial and Medi-Cal plans. Billing team must verify member eligibility and clinical protocols before prescribing. For buprenorphine patients, providers should document baseline dental evaluation and patient counseling about dental risks in medical records.

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