MedicaidPrior AuthHigh impact
24-488 Medical Medication Prior Authorization Changes
Health Net·CA · Oncology, Hematology, Rheumatology +7 more·Prior Authorization
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
Health Net requires prior authorization for multiple new medical benefit drugs effective at different dates throughout 2024, with new HCPCS codes issued by CMS. The policy includes injection medications, biologics, and specialty treatments across various therapeutic areas, with some additions and removals from existing PA requirements.
Action Required
Immediately: Billing team must update prior authorization requirements for all listed HCPCS codes effective January 1, 2024, April 1, 2024, and August 1, 2024. Configure billing system to require PA before administering or billing for these medications. Remove PA requirements for discontinued medications (Blenrep, Feraheme, Makenna, Sunlenca) effective immediately. Update encounter forms and EMR templates to alert providers of PA requirements. Claims will be denied without proper prior authorization.