MedicaidPrior AuthMedium impact
21-473 Medication Trend Updates and Preferred Drug List Changes - 3rd Quarter 2021
Health Net·CA · Neurology, Hematology, Endocrinology +3 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
CalViva Health updated their Medi-Cal Preferred Drug List for Q3 2021, moving several specialty medications to non-formulary status requiring prior authorization. This affects prescribing and billing for rare conditions including spinal muscular atrophy, hereditary angioedema, and various genetic disorders in Fresno, Kings, and Madera counties.
Action Required
Immediately: Billing team must verify prior authorization requirements for all specialty medications listed in the Q3 2021 formulary update before processing claims. Contact CalViva Health at 888-893-1569 for prior authorization requests. Access the complete Preferred Drug List at provider.healthnet.com under Pharmacy Information to verify current formulary status before prescribing.