MedicaidPrior AuthHigh impact
20-851 Learn What Services Will Now Require a Prior Authorization Request
Health Net·CA · Oncology, Physical Therapy, Occupational Therapy·Prior Authorization
Effective date
Jan 1, 2021
We identified it
Jun 20, 2026
Summary
Health Net and CalViva Health Medi-Cal implemented new prior authorization requirements effective January 1, 2021, including immediate PA requirements for 10 new injectable medications and changes to rehabilitation services (PA now required after 12 visits instead of from visit 1). Several medications were also removed from PA requirements.
Action Required
Immediately: Update billing system to require prior authorization for Durysta, Istodax, Jelmyto, Monoferric, Pemfexy, Sarclisa, Tepezza, Trodelvy, Vyepti, and Zulresso injectable medications. Effective January 1, 2021: Modify rehabilitation services billing to require PA only after 12 combined outpatient therapy visits (visits 1-12 no longer need authorization). Update encounter forms and EMR templates accordingly. Access provider.healthnet.com to verify current PA requirements for all services.