Medicare AdvantagePrior AuthMedium impact
20-439 New Prior Authorization Requirements
Health Net·CA · Oncology, Hematology·Prior Authorization
Effective date
Aug 11, 2020
We identified it
Jun 20, 2026
Summary
Health Net has implemented new prior authorization requirements for specific injectable medications and outpatient pharmaceuticals. Some medications require PA immediately, while others require PA starting August 11, 2020.
Action Required
Immediately: Billing team must obtain prior authorization for Adakveo®, Givlaari® (all listed plans) and Quzyttir™ (Medicare HMO only) before administering. By August 11, 2020: Add prior authorization requirements for 14 additional medications (Blincyto®, Ozurdex®, Synribo®, Vyondys 53®, Erbitux®, Panhematin®, Triptodur®, Yutiq™, Faslodex®, Retisert®, Vectibix®, Zaltrap®, Mozobil®, Revcovi™, Vidaza®) for Medi-Cal FFS, commercial, and Centene Corporation Employee PPO plans. Update billing system to flag these medications for PA verification before claims submission.