Medicare AdvantageCoverageMedium impact
21-846m 2022 Plan Codes, Supplemental Benefits and Cal MediConnect Formulary
Health Net·CA·Prior Authorization
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
Health Net updated Cal MediConnect plan codes for 2022 and removed several drugs from formulary, requiring providers to use specified alternatives or submit Coverage Determination requests for non-formulary drugs. New plan codes are effective for Los Angeles (J97) and San Diego (J98) counties.
Action Required
By January 1, 2022: Update billing system with new Cal MediConnect plan codes - J97 for Los Angeles County (replacing HF0) and J98 for San Diego County (replacing HF1). For patients on removed formulary drugs, providers must submit Coverage Determination requests no sooner than November 1, 2021, or switch to listed alternatives. Contact Medicare Pharmacy Services at 800-867-6564 for authorization questions.