MedicaidPrior AuthMedium impact
24-1135 2025 Prior Authorization Changes to Medical Benefit Medications
Health Net·CA · Oncology, Hematology, Nephrology +2 more·Prior Authorization
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
Health Net Medi-Cal is implementing prior authorization changes for medical benefit medications effective January 1, 2025. Ten new drugs require prior authorization, two existing drugs have changed PA requirements, and four drugs no longer require prior authorization.
Action Required
By January 1, 2025: Billing team must update prior authorization requirements in billing system for all affected J-codes and Q-codes. Add PA requirements for 10 new medications including Anktiva, BeqvezTM, and others. Remove PA requirements for BCG Intravesical, Nuzyra, Sandostatin, and SensiparTM. Update encounter forms and staff training materials. Contact Health Net at 800-675-6110 with questions.