22-744 New Medications Added to Prior Authorization Requirements
Date: 09/09/22
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.
For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.
Get prior authorization for the drugs listed in this update
The below medical benefit medications require prior authorization (PA) per new HCPCS codes issued by the Centers for Medicare & Medicaid Services.
Medication | Effective date |
|---|---|
RylazeTM, SaphneloTM | January 1, 2022 |
FyarroTM, Ryplazim®, SusvimoTM, TivdakTM, Xipere® | April 1, 2022 |
EnjaymoTM, Kimmtrak®, Leqvio®, Tezspire®, Vabysmo®, Vyvgart® | July 1, 2022 |
Go online for current PA requirements
Follow the steps below to find out if any procedures, services or equipment need PA:
- Go to provider website.
- Pre-log in, select Working with Health Net > Additional Resources > Services Requiring Prior Authorization.
Additional information
Providers are encouraged to access Health Net’s* provider portal online for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact the applicable Health Net Provider Services Center within 60 days, by phone or through the Health Net provider website.