MedicaidPrior AuthHigh impact
25-1197 Reminder: Prior Authorization Requirements for Outpatient Pharmaceuticals - Submitted Under Medical Benefit
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net now requires all prior authorization requests for injectable medications to be submitted directly to Health Net Pharmacy Services, not to participating physician groups. Claims submitted without proper Health Net Pharmacy Services authorization will be denied.
Action Required
Immediately: Billing team must verify all injectable medications against Health Net Prior Authorization Requirements lists before billing. Use Form 61-211 for PA requests and submit to Health Net Pharmacy Services via fax (800-869-4325 for self-injectables, 833-953-3436 for physician-administered) or phone (800-977-2273 for self-injectables, 800-867-6564 option 2 for physician-administered). Stop accepting PPG authorizations for Health Net claims. Include Health Net Pharmacy Services authorization approval with all claims to avoid denials.