Medicare AdvantageCoverageMedium impact
20-937m 2021 Plan Codes, Supplemental Benefits and Cal MediConnect Formulary
Health Net·CA · Family Medicine, Internal Medicine, Endocrinology +3 more·Prior Authorization
Effective date
Jan 1, 2021
We identified it
Jun 20, 2026
Summary
Health Net Cal MediConnect (Medicare-Medicaid Plan) has assigned new plan codes for Los Angeles (HF0) and San Diego (HF1) counties effective January 1, 2021. Additionally, several commonly prescribed drugs including insulin products (Humalog, Humulin), migraine medications (Ajovy), and other medications are being removed from the formulary with specific alternatives provided.
Action Required
Immediately: Update billing system with new Cal MediConnect plan codes HF0 (Los Angeles H3237-001) and HF1 (San Diego H3237-002). For patients on removed formulary drugs, submit Coverage Determination requests by calling 1-800-867-6564 or use forms from Health Net Medicare Programs website. Switch patients to listed formulary alternatives where appropriate (e.g., Humalog to Novolog, Ajovy to Aimovig/Emgality). Contact applicable Provider Services Centers within 60 days with questions.