MedicaidPrior AuthMedium impact
20-495 View Medical Necessity Guidelines for Paclitaxel Online in Four Steps or Less
Health Net·CA · Oncology, Hematology·Prior Authorization
Effective date
Feb 14, 2020
We identified it
Jun 20, 2026
Summary
Health Net has implemented medical necessity guidelines for paclitaxel (Abraxane®) requiring prior authorization. Claims submitted outside these medically necessary guidelines will be denied, with the policy effective for claims with dates of service after February 14, 2020.
Action Required
Immediately: Billing team must review Health Net's policy CP.PHAR.176 for paclitaxel (Abraxane) medical necessity criteria at providerlibrary.healthnetcalifornia.com. Ensure prior authorization is obtained for Abraxane administration per the policy guidelines. Update billing workflows to verify medical necessity criteria are met before submitting claims. Claims not meeting medical necessity guidelines will be denied.