You can ask us to cover a prescription drug that has limits or that is not covered. This is called asking for a coverage decision or a coverage determination.
You can ask us to make an exception to our coverage rules. There are different types of exceptions that can be requested.
To ask for an exception, you or your prescriber can email, fax or mail a Coverage Determination Request Form (pdf) to the contact information listed below. You do not have to use the form to ask for an exception.
For some drugs, you or your doctor must get approval from us before you fill your prescription. This is called prior authorization. We may not cover the drug if you don't get approval.
To get prior authorization for a drug, you or your prescriber can email, fax or mail a Coverage Determination Request Form (pdf) to the contact information listed below. You do not have to use the form to ask for an exception.
To ask for an exception or prior authorization, you or your prescriber can email, fax or mail a Coverage Determination Request Form (pdf) to the contact information listed below. You do not have to use the form to ask for an exception. Requests can also be made using the link to the online form below.
We must receive a statement from your prescriber supporting your request. After we receive the statement, we will make our decision. We will send you a letter with our decision.
To submit the form online, please click here.
Members: Contact us
Doctors and Other Prescribers: 1-800-867-6564
To protect your privacy, you can use our Secure Messaging Center. You must log in to Healthnet.com to use Secure Messaging. Please do not send emails to Health Net from your personal email.
Log in to the Secure Messaging Center. Select Compose. Paste medicaredeterminations@healthnet.com in the To: field. Please attach any documents to your secure email message.
Be sure to include:
Health Net Pharmacy Department
Attn: Prior Authorizations
PO Box 419069
Rancho Cordova,
California 95741-9069
1-800-977-8226
To find out more about exceptions and prior authorization, go to Chapter 9 of the Member Handbook or contact us .
Information last updated 09-07-2016
Health Net Community Solutions, Inc. is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees.
H3237_2018_0036 CMS Approved 10032017
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