22-747 New Medications Added to Prior Authorization Requirements
Date: 09/09/22
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.
This information applies to Medi-Cal in Fresno, Kings and Madera 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 the provider portal 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 CalViva Health at 888-893-1569.