CommercialPrior AuthHigh impact
25-743m Avoid Returned Requests - Use New Prior Auth Form for RXs and Step-Therapy Exceptions
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net has released a new Prescription Drug Prior Authorization form (No. 61-211) that must be used for all RX and step-therapy exception requests. The policy also updates contact information with different fax and phone numbers for Commercial vs Medi-Cal plans, and specifies that requests using incorrect forms will be returned for resubmission.
Action Required
Immediately: Download new Prescription Drug Prior Authorization form (No. 61-211) from Health Net provider library. Update all prior authorization workflows to use only the new form - old forms will be rejected. Train staff on new contact information: Commercial plans use 866-399-0929 fax for pharmacy requests and 844-235-5090 for physician-administered medications. Medi-Cal uses 800-869-4325 for self-administered and 833-953-3436 for physician-administered medications. Failure to use correct forms will result in returned requests and delays.