MedicaidPrior AuthMedium impact
21-748 Prior Authorization! Find Out What's New or Changing
Health Net·CA·Prior Authorization
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
Health Net is implementing new prior authorization requirements for Cal MediConnect (Medicare-Medicaid Plan) effective January 1, 2022. Multiple new injectable medications now require prior auth, community support services are being added to PA requirements, and wheelchair repairs under $250 are being removed from PA requirements.
Action Required
Immediately: Billing team must update prior authorization workflows for Health Net Cal MediConnect patients receiving Aduhelm, Amondys 45, Danyelza, Margenxa, Pepaxto, Cosela, Jemperli, Rybrevant, Zynlonta, Abecma, Empaveli, Fensolvi, Nexviazyme, and Sotradecol. Add PA requirements for community support services including asthma remediation, housing services, medically tailored meals, recuperative care, and sobering centers. Remove PA requirements for wheelchair repairs under $250. Access Health Net provider portal for real-time PA status verification.