Employer Plan Pharmacy Benefits

We created this Pharmacy Benefits Member Guide to make it easier for you to understand and get the most from your pharmacy benefit coverage. It will also give you important cost-saving options. Since some plans may differ from others, you'll want to Log in to access your coverage documents for details about your specific plan benefits.

Understanding My Pharmacy Benefits Download (PDF)

Tiered Benefit Plans

Our two- and three-tier plans give you both generic and brand name prescription drug coverage. You get easy-to-use pharmacy programs that offer the convenience you want with the value you're looking for.

Some plans may also have a Specialty Tier, which is covered under the pharmacy benefit. Specialty Tier drugs will usually be provided by a specialty pharmacy identified by us. Most of these drugs require prior authorization. Please refer to your plan documents and our Recommended Drug List for specific coverage, copay and tier information.

About Plan Deductibles

Some plans have an annual deductible – the amount you pay before your plan benefits will pay for covered services. If your plan has an annual deductible, it means you pay:

• The full price of your prescription until you reach the deductible amount.
• Only the copay or coinsurance amount, based on your benefit plan, after you've met the deductible amount.

Check your plan documents to see if you have a plan deductible and how it works with your benefit plan.

Comprehensive Pharmacy Network

We have an extensive pharmacy network throughout the country, so it's easy to find a network pharmacy near your home or office. Network pharmacies include major supermarket-based and privately owned pharmacies throughout California, as well as major pharmacy chains throughout the United States. When you fill your prescriptions at one of our network pharmacies, you receive your prescription drugs at the highest available benefit coverage under your plan. By using an out-of-network pharmacy, you may have to pay full price for your prescription.

Supplemental Plan Provider Search

If you have a Health Net supplemental care plan, you can still search for a provider in your area. Learn more by following these links.

• Alternative Care Provider Search
• Behavioral Health Provider Search
• Dental Provider Search
• Vision Provider Search
• Cigna Healthcare PPO Network Providers – log in to Health Net member account, select Find a Provider and then Search National PPO Network to find a provider online.

1. View the mail order options below.
   • CVS Caremark Mail Order Pharmacy
     • CVS Caremark Mail Order - English (PDF)
     • CVS Caremark Mail Order - Spanish (PDF)
2. Complete both sides of the Mail Order Pharmacy Form.
3. Mail the completed Mail Order Pharmacy Form with your original prescription(s) (no photocopies) and payment or credit card number for your copayment(s) or coinsurance to the address listed on the form.

If you're a new or existing Health Net member and your doctor orders a new drug, check to see if it is on our drug list and if it requires a prior authorization. If it does require a prior authorization (noted on the drug list with a "PA"), ask your doctor to contact Health Net to request coverage for the prescribed drug.

What is prior authorization?

Prior authorization is the process of getting approval from us for certain drugs before they are covered. This process is one of the ways we ensure our members get the safest drugs with the best value. We will approve prior authorization requests when medical necessity has been confirmed.

To request prior authorization, your prescriber must complete and fax a Prior Authorization form (PDF) to 866-399-0929.

View Our Prior Authorization Guidelines

Once we receive the request, we will review it to see if it can be approved. If we deny the request, we will tell you why it was denied. We will also tell you how to appeal the decision.