MedicaidPrior AuthMedium impact
21-294 New Medications Added to the Prior Authorization Requirements List
Health Net·CA · Oncology, Hematology, Neurology +4 more·Prior Authorization
Effective date
Jan 1, 2021
We identified it
Jun 20, 2026
Summary
Health Net California has added 12 new medications to their prior authorization requirements list, effective immediately for Medi-Cal members in Fresno, Kings and Madera counties. These include newly approved injectable medications and FDA-approved specialty drugs that now require prior authorization before coverage.
Action Required
Immediately: Billing team must update prior authorization workflows to require PA for 12 new medications (Blenrep, Monjuvi, Scenesse, Spravato, Tecartus, Uplizna, Viltepso, Zepzelca, Oxlumo, Breyanzi, Evkeeza, Nulibry) for Medi-Cal patients in Fresno, Kings and Madera counties. Access PA forms at Health Net provider website under 'Services Requiring Prior Authorization'. Contact CalViva Health at 888-893-1569 with questions. Claims for these medications will be denied without prior authorization.