21-293 New Medications Added to the Prior Authorization Requirements List
Date: 04/15/21
This information applies to Hospitals/Clinics.
For Medi-Cal, this information applies to LA-DHS.
Medications requiring PA immediately for all products
The below medications require prior authorization (PA) per new injectable medication HCPCS codes issued by the Centers for Medicare & Medicaid Services on January 1, 2021.
- Blenrep
- Monjuvi®
- Scenesse®
- Spravato®
- Tecartus™
- Uplizna®
- Viltepso®
- Zepzelca™
The following medications were approved by the U.S. Food and Drug Administration (FDA) and require PA:
Medication | FDA Approval Date |
|---|---|
Oxlumo™ (lumasiran) | November 23, 2020 |
Breyanzi® (lisocabtagene maraleucel) | February 5, 2021 |
Evkeeza™ (evinacumab-dgnb) | February 11, 2021 |
Nulibry™ (fosdenopterin) | February 26, 2021 |
View PA requirements online
Access PA lists, request forms and validation tools with these steps:
- Go to the provider website.
- Pre-log in, select Working with Health Net. Under Additional Resources, select Services Requiring Prior Authorization.
Additional information
If you have questions regarding the information contained in this update, contact the Health Net Medi-Cal Provider Services Center at 800-675-6110.