21-290 New Medications Added to the Prior Authorization Requirements List
Date: 04/15/21
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.
For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.
Medications requiring PA immediately for all products
The below medications require prior authorization (PA) per new injectable medication HCPCS codes issued by the Centers for Medicare & Medicaid Services on January 1, 2021.
- Blenrep
- Monjuvi®
- Scenesse®
- Spravato®
- Tecartus™
- Uplizna®
- Viltepso®
- Zepzelca™
The following medications were approved by the U.S. Food and Drug Administration (FDA) and require PA:
Medication | FDA Approval Date |
|---|---|
Oxlumo™ (lumasiran) | November 23, 2020 |
Breyanzi® (lisocabtagene maraleucel) | February 5, 2021 |
Evkeeza™ (evinacumab-dgnb) | February 11, 2021 |
Nulibry™ (fosdenopterin) | February 26, 2021 |
View PA requirements online
Access PA lists, request forms and validation tools with these steps:
- Go to the Health Net provider website.
- Pre-log in, select Working with Health Net. Under Additional Resources, select Services Requiring Prior Authorization.
Additional information
If you have questions regarding the information contained in this update, contact the applicable Health Net Provider Services Center within 60 days at:
Line of Business | Telephone Number | Provider Portal | Email Address |
|---|---|---|---|
EnhancedCare PPO (IFP) | 1-844-463-8188 | ||
EnhancedCare PPO (SBG) | 1-844-463-8188 | provider_services@healthnet.com | |
Health Net Employer Group HMO, POS, HSP, PPO, & EPO | 1-800-641-7761 | provider_services@healthnet.com | |
IFP (CommunityCare HMO, PPO, PureCare HSP, PureCare One EPO) | 1-888-926-2164 | provider_services@healthnet.com | |
Medi-Cal | 1-800-675-6110 | N/A |