MedicaidPrior AuthHigh impact
24-490 Medical Medication Prior Authorization Changes and NIA Name Change
Health Net·CA · Oncology, Neurology, Rheumatology +6 more·Prior Authorization
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
New prior authorization requirements for 30+ specialty medication HCPCS codes taking effect in 2024, with some additions/removals for specific drugs. NIA has rebranded to Evolent Specialty Services but processes remain unchanged.
Action Required
Immediately: Update billing system to require prior authorization for all listed HCPCS codes effective January 1, 2024 and April 1, 2024. Add PA requirements for Benlysta (J0490) for all ages and Trodelvy (J9317) effective August 1, 2024. Remove PA requirements for Blenrep (J9037), Feraheme (Q0138), Makenna (J1726), and Sunlenca (J3490). Update staff on NIA name change to Evolent - existing portals and processes remain the same. Claims will be denied without proper prior authorization.