MedicaidPrior AuthMedium impact
21-726 Medication Trend Updates and Formulary Changes - 4th Quarter 2021
Health Net·CA · Oncology, Neurology, Internal Medicine +1 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
CalViva Health Medi-Cal updated their formulary for Q4 2021, adding three new injectable medications (Abecma, Aduhelm, and Nulibry) that require prior authorization under medical benefit. The policy also includes new buprenorphine prescribing guidelines for opioid use disorder treatment with expanded access for physicians.
Action Required
Immediately: For CalViva Health Medi-Cal patients in Fresno, Kings, and Madera counties, billing team must verify prior authorization is obtained before administering Abecma (idecabtagene vicleucel), Aduhelm (aducanumab), or Nulibry (fosdenopterin) IV infusions. Update billing system to flag these medications as requiring PA verification. Providers should use the CalViva Health portal for real-time PA status checks.