MedicaidPrior AuthMedium impact
20-089 Prior Authorization Requirements
Health Net·CA · Endocrinology, Oncology·Prior Authorization
Effective date
Apr 1, 2020
We identified it
Jun 20, 2026
Summary
Health Net is implementing new prior authorization requirements for LA-DHS hospitals and clinics effective April 1, 2020. Continuous glucose monitoring now requires prior auth for adult members 21+, and several specialty pharmaceuticals (Aliqopa, Azedra, Beovu, Besponsa, Folotyn, Kanuma, Lutathera, Polivy) now require prior authorization when submitted under the medical plan.
Action Required
Immediately: Billing team must verify prior authorization for continuous glucose monitoring (DME) for adult Health Net Medi-Cal members ages 21 and over before services. Update prior auth checking procedures to include the listed specialty pharmaceuticals (Aliqopa, Azedra, Beovu, Besponsa, Folotyn, Kanuma, Lutathera, Polivy) when submitting under medical plan. Use Health Net provider portal at provider.healthnet.com to verify current prior auth requirements. Contact Health Net Medi-Cal Provider Services at 1-800-675-6110 with questions.