25-743m Avoid Returned Requests - Use New Prior Auth Form for RXs and Step-Therapy Exceptions
Date: 08/19/25
There is new contact information for submitting prior authorization requests
A new version of the Prescription Drug Prior Authorization or Step Therapy Exception Request form (No. 61-211) is now available for use on the Health Net provider library under “Forms and References” at:
Please note that requests made with incorrect forms will be returned to the provider or facility for resubmission. When submitting a form for Health Net members, please note the contact information differs based on the line of business for which the prior authorization request is being made.
Prior authorization contact information: Commercial (HMO and PPO)
Prior authorization type | Contact | Fax | Phone |
|---|---|---|---|
Pharmacy and self-injectable requests | Pharmacy services | 866-399-0929 |
Option 2 |
Physician-administered medications | Pharmacy services | 844-235-5090 |
Option 2 |
Prior authorization contact information: Medi-Cal
Prior authorization type | Contact | Fax | Phone |
|---|---|---|---|
Self-administered medication requests | Medi-Cal Rx | 800-869-4325 | |
Physician-administered medications | Pharmacy services | 833-953-3436 |
Option 2 |
Additional information
Relevant sections of Health Net’s provider operations manuals have been revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library on Health Net’s provider portal.
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by telephone or through the Health Net provider portal.
Provider Services
Line of business | Phone number | |
Ambetter from Health Net IFP Ambetter PPO | ||
Ambetter HMO | Provider_services@healthnet.com | |
Health Net Employer Group HMO, POS, & PPO | Provider_services@healthnet.com | |
Medi-Cal (including CS and ECM providers) | N/A |
This information applies to Physicians and Participating Physician Groups (PPGs).
For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, Molina, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.