Prior Authorization Revisions for Commercial Members

Stethoscope and pills

We regularly review our Prior Authorization Lists (PALs) to ensure we deliver the right balance of value and stability to members.

The following information outlines some of the changes taking effect July 1, 2017, for certain commercial members with policies from Health Net of California, Health Net of Arizona, Health Net Health Plan of Oregon and Health Net Life Insurance Company.

 

Health Net of California and Health Net Life Insurance Company

 

The PAL revisions are for commercial products (Direct Network HMO – including CommunityCare – plus EPO, HSP, POS, PPO and Flex Net).

 

New outpatient items requiring prior authorization when billed under the medical benefit are:

  • Select outpatient pharmaceuticals: Elelyso®, Exondys 51, Inflectra™, Spinraza™, Zinplava.
  • Testosterone therapy provided in the physician’s office.
  • Newly approved medications may require prior authorization. To confirm whether a specific new medication requires prior authorization, contact Health Net. 

 

These new revisions apply only to subscribers whose authorization requirements are managed by Health Net.  California commercial products subscribers have access to this information online at healthnet.com. If they have questions regarding the information, they should contact the Health Net Customer Contact Center either online at healthnet.com or by telephone at 1-800-522-0088. Customer Contact Center hours are Monday through Friday, 8 a.m. to 6 p.m., except federal holidays.

 

Health Net of Arizona and Health Net Life Insurance Company

 

New outpatient items requiring prior authorization when billed under the medical benefit are: 

    • Select outpatient pharmaceuticals: Elelyso®, Exondys 51, Inflectra™, Spinraza™, Zinplava.
    • Newly approved medications may require prior authorization. To confirm whether a specific new medication requires prior authorization, contact Health Net.

 

For a copy of the current PAL requirements, members may:

  •  Log in to our website at healthnet.com. Then, under My Coverage, click Preauthorizations > Prior Authorization List.

 

  • Call Health Net at the numbers below.

 

If members have questions, they may contact the Health Net Customer Contact Center online at healthnet.com or by telephone:

 

  • 1-800-289-2818 (TTY: 711) for Health Net of Arizona and Health Net Life commercial members.
  • 1-888-926-1870 (TTY: 711) for those enrolled in a Health Net plan through the Health Insurance MarketplaceOur Customer Contact Center is available Monday through Friday, 7:30 a.m. to 5 p.m., except federal holidays.

 

Health Net Health Plan of Oregon

 

PAL revisions apply to our commercial members (EPO, POS, CommunityCare, and PPO). New outpatient items requiring prior authorization when billed under the medical benefit are:

    • Select outpatient pharmaceuticals: Elelyso®, Exondys 51, Inflectra™, Spinraza™, Zinplava.
    • Newly approved medications may require prior authorization. To confirm whether a specific new medication requires prior authorization contact Health Net.

 

For a copy of the current PAL requirements, members may log in to our website at healthnet.com. Then, under My Coverage, click Preauthorizations > Prior Authorization List. Or they may call 1-888-802-7001 (TTY: 711). Our Customer Contact Center hours are Monday through Friday, 7:340 a.m. to 5 p.m., except federal holidays.

 

 

 

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Brad Kieffer