MedicaidCoverageMedium impact
26-784m Medication Trend Updates and Drug List/Formulary Changes - 3rd Quarter 2026
Health Net·CA · Pharmacy·Pharmacy
Effective date
Jul 1, 2026
We identified it
Jul 2, 2026
Summary
HealthNet California has released a quarterly pharmacy policy update (26-784m) effective July 1, 2026, covering medication trend updates, drug list/formulary changes, and medication safety issues for Medi-Cal members in Imperial County. The billing team must review the linked Provider Update PDF to identify specific formulary changes, prior authorization requirements, and covered medication adjustments that may affect claim processing and reimbursement.
Action Required
By July 1, 2026: Billing team must download and review the Provider Update PDF from the HealthNet provider library (providerlibrary.healthnetcalifornia.com) to identify specific drug formulary changes, new prior authorization requirements, and medication safety updates. Update billing system rules, encounter templates, and prior authorization workflows to reflect any changes to covered medications, tier assignments, and authorization processes for Medi-Cal members in Imperial County. Communicate changes to providers and front desk staff. Failure to implement updates may result in claim denials for non-formulary medications or missing prior authorizations.