24-1315sum Summary Update: New Prior Authorization Changes, Effective March 1, 2025

Date: 12/19/24

Learn which drugs have been added, changed or removed for medical benefit medications

Refer to the complete update, 24-1315, New Prior Authorization Changes, Effective March 1, 2025, for prior authorization changes for Commercial (HMO, Point of Service (POS), PPO), Ambetter HMO/PPO and Medi-Cal fee-for-service physicians and other providers.

Key information includes:

• Changes to Outpatient Pharmaceuticals (Submitted under Medical Benefit) that require prior authorization effective March 1, 2025.
• New CPT and HCPCS Codes issued by the Centers for Medicare & Medicaid Services (CMS) that require prior authorization as of  
  October 1, 2024.
• A new supplemental form that has been added to the Outpatient Prior Authorization Form to complete when an authorization request involves more than four procedure codes.

Access the form on the Prior Authorization web page in the Provider Library > select line of business > Forms and References.

Additional information

If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by phone or through the Health Net provider portal. 
Behavioral health providers can call 844-966-0298.

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

For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.