CommercialPrior AuthHigh impact
24-487 Medical Medication Prior Authorization Changes and NIA Name Change
Health Net·CA · Oncology, Ophthalmology, Neurology +6 more·Prior Authorization
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
Health Net now requires prior authorization for numerous new specialty medications effective January 1, 2024 and April 1, 2024, including oncology, ophthalmology, and rare disease drugs. The policy also removes PA requirements for several discontinued medications and renames NIA to Evolent Specialty Services.
Action Required
Immediately: Update billing system to require prior authorization for all listed HCPCS codes effective January 1, 2024 and April 1, 2024 for Health Net Commercial, Ambetter, and Medi-Cal plans. Remove PA requirements for discontinued medications (Probuphine J0570, Blenrep J9037, Feraheme Q0138, Makenna J1726, Sunlenca J3490). Train billing team on new PA requirements for specialty injections including oncology, ophthalmology, and rare disease medications. Claims will be denied without proper prior authorization.