Skip to Main Content

Provider Digest | Volume 196

Date: 12/10/25

Wellcare By Health Net & Wellcare By Trillium Advantage
2026 Formulary Changes

On January 1, 2026, some drugs will no longer be covered on our Medicare Part D formulary(ies). To assist our providers, we have included the list of the most commonly prescribed drugs being removed along with the drug's 2026 formulary alternative(s). Please refer to the list (PDF) to identify the appropriate options for your patients.

If you determine that it is necessary for your patient to continue to receive the non-formulary drug in 2026, you will need to submit a Coverage Determination request on or after January 1, 2026.

Request forms are located on our website on the Coverage Determinations and Redeterminations for Drugs page or you can call to request authorization.

If you have any questions, please contact Medicare Pharmacy Services at 1-800-867-6564, 8AM to 10:30PM, EST, Monday-Friday.

______________________________________________________

Free ECHO SUD Prevention and Early Intervention Program

The Oregon ECHO Network is an interactive educational and community-building experience that allows healthcare professionals throughout the state of Oregon to create a case-based learning environment through the convenience of video connection.

Starting in January 2026, ECHO is offering a free 12-session virtual, interactive program to support those working on substance use disorder (SUD) prevention and early intervention systems in school contexts. Sessions will exemplify successful models, empower teams to vision together, and assist champions to advance their own prevention efforts.

______________________________________________________

Effective January 1, 2026: Use Availity Essentials for Health Net and Wellcare Behavioral Health Initial Precertification Requests

Earlier this year, Health Net and Wellcare By Health Net Behavioral Health announced a shift to using Availity Essentials as the preferred method for initial facility precertification requests.
 
Please note that effective January 1, 2026, Availity Essentials will be the primary method for Health Net and Wellcare Behavioral Health initial precertification requests.

Availity Provider Registration

Please register and prepare for this transition today! In-network and out-of-network facility providers are encouraged to register and access Availity Essentials on the registration page of the Availity website.
 
Once you set up an account and log in, Availity training webinars can be found by navigating to the Availity Learning Center (ALC). From the home page, select Help & Training > Get Trained > Sessions tab to view the calendar of upcoming sessions.
 
For more information about Availity Essentials, please visit the Availity website or call Availity Client Services at 800-282-4548 (Monday–Friday, 5 a.m.–5 p.m. PT).
 
Secondary Fax Option
Faxed precertification requests will also be accepted.

Note: If your request is for routine psychotherapy or medication management, Transcranial Magnetic Stimulation (TMS), Applied Behavioral Analysis (ABA) or Psychological/Neuropsychological Testing, please see the "Special Instructions" section of this article.
 
Prior Authorization Fax Request Forms (submit Behavioral Health fax requests to 855-663-2244)

For inpatient psychiatric admission, detoxification, SUD rehab, or MH/SUD RTC (if applicable):

For MH/SUD PHP or MH/SUD IOP:

For facility providers seeking initial precertification without access to Availity or fax, telephonic review will still be available by calling our toll free number though hold times may be significantly longer.
 
Special Instructions

  • Routine psychotherapy and medication management with an in-network provider do not require referral or prior authorization. Do not submit via Availity or fax.
  • Prior Authorization requests for Transcranial Magnetic Stimulation (TMS) or Psychological/Neuropsychological Testing are accepted by email to Admin.HNTBH@healthnet.com or via fax to the following numbers:
    • Transcranial Magnetic Stimulation (TMS) fax: 855-661-0077
    • Psychological/Neuropsychological Testing fax: 855-703-3268
  • Prior Authorization requests for Applied Behavioral Analysis (ABA) submissions are accepted by email to ABA@healthnet.com or via fax to 855-427-4798.

If you need additional assistance, please call 844-966-0298.

______________________________________________________