MedicaidPrior AuthMedium impact
21-109 Medication Trend Updates and Preferred Drug List Changes - 1st Quarter 2021
Health Net·CA·Prior Authorization
Effective date
Jan 1, 2021
We identified it
Jun 20, 2026
Summary
CalViva Health Medi-Cal updated their Preferred Drug List for Q1 2021, marking multiple new medications as non-formulary (requiring prior authorization). Additionally, new controlled substance prescribing requirements took effect January 1, 2021, requiring compliant prescription forms and faster CURES reporting within one working day.
Action Required
Immediately: Billing team must update prior authorization requirements for all listed non-formulary medications including Dayvigo, Fintepla, Koselugo, Nexletol, Nurtec ODT, Ongentys, Pemazyre, Qinlock, Retevmo, Tabrecta, Tukysa, Ubrelvy, Xcopri, and Zeposia for Medi-Cal patients in Fresno, Kings and Madera counties. Providers must use new AB 149 compliant prescription forms for controlled substances or pharmacists cannot fill prescriptions. Update controlled substance dispensing reporting to CURES within one working day instead of seven days.