20-442 New Prior Authorization Requirements

Date: 06/08/20

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.

Request prior authorizations for medications listed in this update

The below medications require prior authorization (PA) immediately per new injectable medication HCPCS codes issued by the Centers for Medicare & Medicaid Services (CMS) on April 1, 2020:

• Adakveo^®
• Givlaari^®
• Quzyttir™

The above medications are listed in the PA list under Outpatient Pharmaceuticals (Submitted under Medical Plan).

View PA requirements online

Follow the steps below to find out if PA is needed for any procedures, services or equipment:

1     Go to provider.healthnet.com

2     Before logging in, select Working with Health Net > Policies for Non-Contracting Providers > Additional Resources > Services Requiring Prior Authorization.

3     After logging in, select Working with Health Net > Contractual > Services Requiring Prior Authorization.

Additional information

If you have questions regarding the information contained in this update, contact the Health Net* Provider Services Center by email at provider_services@healthnet.com within 60 days, by telephone or through the Health Net provider website.