CommercialPrior AuthMedium impact
23-1446 Prior Authorization Changes Effective March 1, 2024
Health Net·CA · Oncology, Hematology, Endocrinology +3 more·Prior Authorization
Effective date
Mar 1, 2024
We identified it
Jun 20, 2026
Summary
Health Net is implementing new prior authorization requirements for several medical benefit drugs and vascular procedures, while removing PA requirements for certain echocardiograms and ophthalmology treatments. The changes primarily affect Medi-Cal providers and include new requirements for gene therapy, cancer drugs, and endovascular procedures.
Action Required
By March 1, 2024: Billing team must update prior authorization workflows for new drug codes J9302, J9293, J2502, J9357 and vascular procedure codes 37220-37231 for Medi-Cal patients. Remove PA requirements for Vegzelma (Q5129) for ophthalmology and all echocardiogram procedures. Update billing system flags and provider encounter forms to reflect these changes. Contact Health Net Provider Services within 60 days with questions.