MedicaidPrior AuthMedium impact
20-440 New Prior Authorization Requirements
Health Net·CA · Oncology, Hematology·Prior Authorization
Effective date
Aug 11, 2020
We identified it
Jun 20, 2026
Summary
Health Net California now requires prior authorization for 16 specific medications for Medi-Cal fee-for-service members in Fresno, Kings, and Madera counties. Two medications (Adakveo and Givlaari) require immediate PA, while 14 others require PA starting August 11, 2020.
Action Required
Immediately: Billing team must obtain prior authorization for Adakveo and Givlaari before administering to Medi-Cal FFS members. By August 11, 2020: Obtain prior authorization for Blincyto, Ozurdex, Synribo, Vyondys 53, Erbitux, Panhematin, Triptodur, Yutiq, Faslodex, Retisert, Vectibix, Zaltrap, Mozobil, Revcovi, and Vidaza. Submit PA requests under Medical Plan for Outpatient Pharmaceuticals category. Update billing system alerts and staff training materials. Claims will be denied without proper prior authorization.