Medicare AdvantagePrior AuthHigh impact
21-295 New Medications Added to the Prior Authorization Requirements List
Health Net·CA · Oncology, Hematology, Nephrology +1 more·Prior Authorization
Effective date
Jan 1, 2021
We identified it
Jun 20, 2026
Summary
Health Net has updated its prior authorization requirements list, adding 13 new medication codes and removing 3 codes from the Part B medication PA requirements. These changes are effective immediately and require billing teams to update their systems to obtain prior authorization for the newly added medications.
Action Required
Immediately: Billing team must update systems to require prior authorization for new medication codes C9069, C9070, C9071, C9072, C9073, J1823, J7212, J7352, J9144, J9223, J9281, J9316, J9317, Q5122, and S0013. Remove PA requirements for deleted codes C9062, C9064, and C9066. Update encounter forms and alert providers that these medications now require prior authorization. Access updated PA forms and validation tools through Health Net provider portal under Services Requiring Prior Authorization.