CommercialPrior AuthMedium impact
20-442 New Prior Authorization Requirements
Health Net·CA · Oncology, Hematology, Gastroenterology +1 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net now requires prior authorization for three specific injectable medications: Adakveo®, Givlaari®, and Quzyttir™, effective immediately. These medications must be submitted under the Medical Plan as Outpatient Pharmaceuticals and require PA before administration.
Action Required
Immediately: Billing team must verify prior authorization requirements for Adakveo®, Givlaari®, and Quzyttir™ before administering these injectable medications. Update prior authorization workflow to include these three medications under Outpatient Pharmaceuticals (Medical Plan). Staff should check provider.healthnet.com for PA requirements and contact provider_services@healthnet.com with questions within 60 days.