21-561 New Fax Numbers to Request Prior Authorization for Medications

Date: 07/29/21

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

For Medi-Cal, this information applies to LA-DHS.

Effective October 1, 2021, fax prior authorization requests for medications to the numbers listed below

Use the appropriate fax numbers when requesting prior authorization (PA) for the following:

Types of Request	New Fax Number
Pharmacy PA For initial PA and formulary exception requests for medications that are prescribed to a member and covered under the pharmacy plan and dispensed by a network pharmacy.	866-399-0929
Medical pharmacy PA For medications that are covered under a member’s medical plan and are administered by a health care professional in a provider’s office, outpatient hospital, infusion center or through a home infusion provider.	833-953-3436

You may continue to fax PA requests for medications with the current fax number until October 1, 2021.

Additional information

If you have questions regarding the information contained in this update, contact the Health Net Medi-Cal Provider Services Center at 800-675-6110.