MedicaidPrior AuthMedium impact
20-088 Prior Authorization Requirements
Health Net·CA · Endocrinology, Gastroenterology, Oncology +1 more·Prior Authorization
Effective date
Apr 1, 2020
We identified it
Jun 20, 2026
Summary
Health Net has implemented new prior authorization requirements for continuous glucose monitoring, specific outpatient pharmaceuticals (Aliqopa, Azedra, Beouvu, Besponsa, Folotyn, Kanuma, Lutathera, Polivy, Remodulin), and H. pylori antibody testing. Transplant procedures now require use of Health Net's designated specialty network instead of HLA typing authorization.
Action Required
Immediately: Update billing workflows to obtain prior authorization for continuous glucose monitoring (CGM) devices, H. pylori antibody testing, and the specified outpatient pharmaceuticals (Aliqopa, Azedra, Beouvu, Besponsa, Folotyn, Kanuma, Lutathera, Polivy, Remodulin) before scheduling or ordering. Remove HLA typing from transplant prior authorization requirements and ensure all transplant procedures are scheduled through Health Net's designated transplantation specialty network. Update encounter forms and EMR reminders accordingly.