MedicaidPrior AuthHigh impact
25-742m 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) and updated contact information for submitting prior auth requests. All prior authorization requests made with outdated forms will be returned for resubmission, requiring immediate adoption of the new form.
Action Required
Immediately: Download new Prescription Drug Prior Authorization form (No. 61-211) from Health Net provider library. Update all prior auth workflows to use new contact information: Self-administered medications (Medi-Cal Rx): Fax 800-869-4325, Phone 800-977-2273. Physician-administered medications (Pharmacy services): Fax 833-953-3436, Phone 800-867-6564 Option 2. Train staff on new form requirements. Failure to use correct forms will result in returned requests requiring resubmission.