CommercialPrior AuthMedium impact
21-724 Medication Trend Updates and Formulary Changes - 4th Quarter 2021
Health Net·CA · Oncology, Neurology, Psychiatry +1 more·Prior Authorization
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
Health Net updated their formulary and pharmacy policies for Q4 2021, adding new high-cost medications requiring prior authorization and implementing a new Pharmacy Lock-In Program for Individual Market members starting 2022. New buprenorphine prescribing guidelines allow physicians to treat up to 30 opioid use disorder patients without special certification.
Action Required
Before January 1, 2022: Billing team must update prior authorization requirements for new injectable medications Abecma, Aduhelm, and Nulibry (all require medical benefit PA). Providers should be notified of new Pharmacy Lock-In Program criteria that may affect Individual Market members with substance use patterns. Update buprenorphine prescribing protocols to reflect new 30-patient limit for exempt physicians.