MedicaidPrior AuthMedium impact
21-750 Prior Authorization! Find Out What's New or Changing
Health Net·CA·Prior Authorization
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
Health Net and CalViva Health Medi-Cal in Fresno, Kings, and Madera counties now requires prior authorization for several new injectable medications and community support services effective January 1, 2022. Some existing prior authorization requirements for pediatric subspecialist procedures and wheelchair repairs under $1,500 have been removed.
Action Required
By January 1, 2022: Billing team must update prior authorization requirements in billing system for new injectable medications (Aduhelm, Amondys 45, Danyelza, Margenzia, Pepaxto, Cosela, Jemperli, Rybrevant, Zynlonta) and outpatient pharmaceuticals (Abecma, Empaveli, Fensolvi, Nexviazyme, Sotradecol). Add community support services to prior auth list including asthma remediation, housing services, recuperative care, meals, and sobering centers. Remove prior auth requirements for pediatric subspecialist testing/procedures and adult wheelchair repairs under $1,500. Access Provider Portal for real-time authorization status verification.