CommercialPrior AuthMedium impact
21-107 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
Health Net updated their formulary and preferred drug list for Q1 2021, moving several new medications to non-formulary status or higher tiers requiring prior authorization. The FDA is also proposing withdrawal of Makena (preterm birth prevention drug) and new controlled substance prescribing rules took effect January 1, 2021.
Action Required
Immediately: Billing team must verify prior authorization requirements for newly listed non-formulary medications including Dayvigo, Nexletol, Nurtec ODT, and others before prescribing to Health Net members. Update prior auth workflow to check current formulary status. For controlled substances, ensure providers use new security prescription forms per AB 149 requirements effective January 1, 2021. Contact Health Net pharmacy services at 1-800-548-5524 for commercial or 1-800-867-6564 for Medi-Cal/Medicare coverage verification.