MedicaidPrior AuthHigh impact
25-741m 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/CalViva Health has released a new Prescription Drug Prior Authorization form (No. 61-211) and updated contact information for submitting prior auth requests. Using incorrect or old forms will result in returned requests that must be resubmitted.
Action Required
Immediately: Download the new Prescription Drug Prior Authorization or Step Therapy Exception Request form (No. 61-211) from the Health Net provider library. Update all prior auth submission processes to use the new form and contact information: Self-administered medications to Medi-Cal Rx (fax 800-869-4325, phone 800-977-2273), Physician-administered medications to Pharmacy services (fax 833-953-3436, phone 800-867-6564 Option 2). Train staff on new contact requirements for CalViva Health members in Fresno, Kings, and Madera counties. Using old forms will result in returned requests requiring resubmission.