CommercialPrior AuthMedium impact
23-1236 Prior Authorization Changes Effective January 1, 2024
Health Net·CA · Oncology, Hematology, Nephrology +3 more·Prior Authorization
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
Health Net is implementing new prior authorization requirements for 9 specialty medications (including injectable drugs for rare conditions and hemophilia) and removing prior auth requirements for Sublocade injections for commercial members. Additionally, Medi-Cal pediatric members under 21 now require prior authorization for long-term care nursing facility admissions.
Action Required
Immediately: Update billing system to require prior authorization for 9 new HCPCS codes (C9155, C9157, J0801, J0802, J0889, J2781, J7214, J9051, J9345) for specialty injectable medications. Remove prior auth requirements for Sublocade injections (Q9991, Q9992) for commercial members only. For Medi-Cal providers: implement prior authorization process for pediatric long-term care nursing facility admissions using fax 855-851-4563 or phone 800-453-3033. Claims will be denied without proper prior authorization.