CommercialPrior AuthHigh impact
20-850 Learn What Services Will Now Require a Prior Authorization Request
Health Net·CA·Prior Authorization
Effective date
Jan 1, 2021
We identified it
Jun 20, 2026
Summary
Health Net is implementing extensive prior authorization changes effective January 1, 2021, including immediate PA requirements for 10 new injectable medications and new requirements for biosimilars across all plan types. Several medications are being removed from PA requirements while rehabilitation therapy visits 1-12 no longer require authorization.
Action Required
By January 1, 2021: Billing team must update prior authorization workflows to require PA for biosimilars instead of branded drugs across all Health Net plans. Update system to automatically require PA for Durysta, Istodax, Jelmyto, Monoferric, Pemfexy, Sarclisa, Tepezza, Trodelvy, Vyepti, and Zulresso injectable medications. Remove PA requirements for rehabilitation therapy visits 1-12 (still required after 12 combined visits). Update encounter forms and train staff on new biosimilar requirements to avoid claim denials.