Extended-duration PA removal — actions and implications

Effective August 3, 2026, the extended-duration prior authorization (PA) policy will no longer apply to the listed drugs and drug classes. Claims submitted for these drugs without an approved extended-duration PA will deny with Reject Code 75 - Prior Authorization Required. Prescribers may change to covered alternatives, or if no appropriate alternatives exist, submit a new PA request for coverage consideration. PA requests may be approved for up to 12 months, as clinically appropriate.

• Deny reason: Reject Code 75 - Prior Authorization Required
• If no appropriate alternative exists, submit a new PA request
• PA approvals may be issued for up to 12 months where clinically appropriate

Notice — listed drugs and categories (background)

This document provides background listing of drugs and product categories that are included in the extended-duration PA policy updates so providers can identify affected products.

• Examples include ophthalmic immunomodulators (Cequa, VERKAZIA, VEVYE, Xiidra), oncology agents, and various CNS and bone-health drugs listed in the notice.

Notice to providers — review affected medications

Pharmacy providers and prescribers are notified that extended-duration PA requirements are changing and should review the listed medications to determine clinical impact and next steps for patients.

• Review patient therapy for affected medications (listed in the background sections) to determine whether to switch to covered alternatives or submit a PA.

Background product list — informational (no new action)

Background lists of pharmacy products and brand names are provided for informational purposes; these fragments do not specify new provider actions beyond identification of affected products.

• The product lists are informational and reiterate branded formulations (e.g., Binosto, Boniva, Atelvia, Zometa) without adding new PA steps.

Medication list (background) — identify impacted drugs

Medication names and formulations are enumerated as background to the PA update; providers should use these lists to identify impacted prescriptions but no explicit additional steps are specified in these passages.

• Listed examples include Prolia, Xgeva, Jubbonti, and various bisphosphonate formulations.

Drug list background — informational

The document contains repeated listing of drugs and branded products referenced in the prior authorization updates; these background excerpts are informational and do not change PA submission requirements beyond the removal noted in the effective-date guidance.

• Repeated entries include denosumab products (Prolia, Xgeva, biosimilars) and bisphosphonates (alendronate, risedronate, ibandronate).

Drug list referenced in prior authorization updates — verify affected products

Lists multiple pharmacy products referenced as part of the PA updates (for example: alendronate/Binosto, risedronate/Atelvia, denosumab/Prolia/Xgeva and biosimilars, cyclosporine products, and named biosimilars). Use these lists to verify whether a drug you prescribe or dispense is affected by the extended-duration PA change.

• Examples in this section: Prolia, Xgeva, Jubbonti, Wyost, Conexxence, OSPOMYV and various bisphosphonate products.

Provider actions for PA changes — change therapy or submit PA

When the extended-duration PA requirement is removed for listed drugs, prescribers should either select covered alternatives that may not require a PA or, if a therapy change is not clinically appropriate, submit a PA request using approved Medi‑Cal Rx submission methods. Review the Prior Authorization Submission Reminders and medical necessity guidance when submitting requests.

• Consider alternate covered therapies that may not require a PA, when clinically appropriate.
• If therapy change is not appropriate, submit a PA request via an approved Medi‑Cal Rx submission method and follow PA submission reminders.

Reference covered products lists — check coverage and Code I limits

Refer to the Contract Drugs & Covered Products Lists page on the Medi‑Cal Rx Web Portal to confirm whether a drug/product is eligible as a pharmacy benefit and to identify any Code I limitations.

• Check the Medi‑Cal Rx Approved NDC List for covered alternatives.
• Use the Contract Drugs & Covered Products Lists to confirm Code I limitations that may affect coverage.