Pharmacy Creditable Coverage - Employer Required Notice to Employees
Under federal Centers for Medicare & Medicaid Services (CMS) requirements, employers who offer prescription drug coverage through a group-sponsored health plan must notify Medicare-eligible employees by October 15 each year whether their pharmacy coverage is considered Creditable Coverage or Non-Creditable Coverage.
To support our employer groups in meeting this requirement, we are mailing letters that outline the notice obligation and reference the CMS model notices employers may use. For your convenience, we’ve also recapped the requirement below, so you have the details at hand when meeting with your clients.
2025–2026 Health Net Pharmacy Plans
- All Health Net Commercial Small and Large Group pharmacy plans available for the 2026 plan year (in place as of September 15, 2025) provide Creditable Coverage.
- If an employer group changes its pharmacy coverage at renewal and selects a plan built or modified after September 15, 2025, the group must contact its Health Net representative to confirm whether the new plan provides Creditable Coverage.
Employer Action Required
- Employers must ensure Medicare-eligible employees receive this notice no later than October 15, 2025. CMS provides model notices that may be used to satisfy this requirement.
Resources
- Broker & Employer Portals – Notifications are available under the Brokers or Employers tab. Navigate to Pharmacy Plan Information → Pharmacy Resources → Non-Creditable Pharmacy Plans (PDF) for easy reference.
- CMS Website – Employers can access additional details on Creditable Coverage, including the CMS Model Beneficiary Creditable Coverage Disclosure Notice and the CMS Online Disclosure Form.
Please note:
Members enrolled in Individual & Family (IFP) plans will be notified directly by Health Net regarding their plan’s creditable coverage status. The list of Non-Creditable Pharmacy Plans will also be posted and available under: Pharmacy Information → Creditable Coverage Notification.
Need Help?
For questions, please reach out to your Health Net Commercial Sales Team.