MedicaidPrior AuthMedium impact
21-325 Medication Trend Updates and Preferred Drug List Changes - 2nd Quarter 2021
Health Net·CA · Oncology, Endocrinology, Neurology +3 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
CalViva Health updated their Medi-Cal Preferred Drug List for Q2 2021, adding several specialty medications as non-formulary requiring prior authorization, and reinforcing their preference for biosimilar medications over brand-name biologics with step therapy requirements.
Action Required
Immediately: Billing team must update prior authorization workflows for new non-formulary medications including Dojolvi, Gavreto, Inqovi, Isturisa, Lampit, Jelmyto, Uplizna, and Viltepso. Verify biosimilar step therapy requirements are met before submitting claims for brand biologics (Epogen, Neupogen, Neulasta, Remicade, Rituxan, Avastin, Herceptin). Contact CalViva Pharmacy Department at 800-867-6564 for prior authorization questions. Claims for non-formulary drugs without prior authorization will be denied.