Pharmacy FAQs

View our Frequently Asked Questions for answers to other common pharmacy-related questions.

1. How do I use my Health Net prescription benefit?
Once you obtain a prescription from your physician, you can receive up to a month's supply that can be filled at one of the Health Net participating pharmacies. Be sure to fill all non-emergency prescriptions at a participating pharmacy to ensure they will be covered under your pharmacy plan benefits.

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2. How can I find a Health Net participating pharmacy?
You may access most participating chain pharmacies almost anywhere in the United States. Specialty pharmacy and mail order pharmacy medications must be obtained from one of Health Net's designated Specialty pharmacies or our Mail Order pharmacy.

To locate a participating pharmacy, search the Pharmacy Locator.

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3. How do I know what is included in my pharmacy benefit?
Consult your plan's Coverage Document for an accurate description of what is included in your Health Net pharmacy benefit.

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4. How do I know what my copayment will be?
After you log in, you can select "View Prescription Coverage" and then "copay amounts," or review your plan Coverage Document, or you may contact Customer Service.

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5. How can I work with my provider to get the best benefit from Health Net's Drug Lists?
Your physician, pharmacist or other prescriber can help you to get the best benefit.

Here are some tips:

  • Ask your physician to prescribe generic products from our drug list whenever possible.

  • If a medication you need is not available as a generic, or is non-preferred, ask your physician to choose a brand-name product that is on our drug list.

  • Take your drug list with you whenever you visit physician.

  • Tell your physician it is important that you pay the lowest copayment possible as long as the medication is right for your medical condition.

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6. What does Prior Authorization (PA) mean?
When a medication is noted on our drug lists as "prior authorization required", your physician must contact us to provide the medical reasons for prescribing this medication. Upon receiving the necessary information, we will assess this information based on established clinical criteria for the particular medication.

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7. What should I do if my medication requires Prior Authorization?
If your medication has a comment on our drug lists that it requires prior authorization, we recommend that you talk with your physician or medical provider as soon as possible about the prescribed medication and alternatives available. If your physician requests a prior authorization, we need to obtain information directly from your provider (this information cannot come from you, the patient). The provider may fax your prior authorization information using our Prior Authorization/Medication Exception Request Form or, if urgent, your physician may call us at: 1-800-410-6565.

If your prior authorization criteria are met, then the drug is approved for coverage at the applicable copayment or coinsurance. If you decide to purchase without prior authorization, you will be responsible for the total cost of the medication.

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8. What does it mean if my drug has a quantity limit?
Some medications may be subject to a dosage -or quantity- limit. This means that you can get a pre-set amount of the medication within a specific time period. If your medication has a quantity limit, but you have been prescribed a dose that exceeds the limit, your physician must obtain prior authorization for the higher quantity.

The medication will not be approved if: medical necessity criteria are not met; there is a less costly alternative; or the medication is not a covered benefit. If you decide to purchase the medication without prior authorization, you will be responsible for the total cost.

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9. How often can I refill my prescriptions?
You may refill prescriptions after 85 percent of the medication from the previous fill has been used as directed. If your physician has increased your dose, he or she needs to notify your pharmacy of the change in directions. Your pharmacy may contact Health Net for an override if this change will result in an early refill request.

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10. How can I get an extra supply of medication if I'm going on vacation?
Health Net’s participating pharmacies enable our members access to their drug benefit nationwide for any additional medication needed while on vacation. If your prescription refill is due while you are on vacation, we may allow for an extra fill if you or your pharmacy notifies us. Please allow extra time for your pharmacy to process your request. You will be responsible for any additional copayment that may apply and will be limited to one additional month. If greater supplies are needed, you may use our Mail Order pharmacy to obtain up to a 3-month supply.

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11. Is there a mail order pharmacy?
Yes. We have a mail order pharmacy for members who have Health Net coverage through their employer. The mail order pharmacy is generally used for maintenance medications, or drugs taken for a chronic medical condition. Our mail order pharmacy allows you to receive up to a 3-month supply of maintenance medications. Self-injectables, with the exception of insulin, are not available through mail order.

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12. What if a medication is not on the Health Net Drug List? Does that mean it's not covered?
Some generic and brand-name medications are secondary choices due to side effects, therapeutic performance, and/or high cost. If you are on a medication that is not on our drug list, ask your physician or medical provider if a covered drug could be right for you. If, after discussing the options with your physician or provider, you find that it is best to remain on a brand-name medication not on our drug lists, you will pay the non-drug list copayment.

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13. How are injectables covered?
All self-injectable medications, except preferred insulins and epinephrine emergency kits, require prior authorization. Most self-injectable medications that are covered by the pharmacy benefit are listed on the Drug List. If you do not find your medication on the Drug List, please contact Customer Service for benefit information.

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14. How are compounded prescriptions covered?
Compounded prescriptions require Prior Authorization for coverage and are subject to your highest copayment if approved. Please contact Customer Service if you have questions about compounded or injectable medication.

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15. Who develops the list of medications included on the Health Net Drug List?
The drug lists are developed and updated by the Health Net Pharmacy and Therapeutics (P&T) Committee, which consists of practicing physicians and pharmacists who are chosen based on their experience, knowledge and expertise in their specialties. Other external physician experts are consulted to provide input. The lists are updated regularly. The latest versions are available online. For more information, call us at the Customer Service for benefit information.

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16. How do I request reimbursement for prescriptions I purchased out-of-pocket?
We recommend that you fill prescriptions at participating pharmacies whenever possible. However, you may be eligible for reimbursement (minus the copayment) on prescriptions filled by an out-of-network pharmacy for emergency medical care.

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17. How do I submit a claim for reimbursement?
Mail a copy of your prescription receipts (not cash register receipts) together with the member's name, Health Net ID number and daytime phone number to:

Health Net of Arizona
Attn: Pharmacy Dept.
5255 E. Williams Circle Suite 4000
Tucson, AZ. 85711

Claims must be submitted within one year of the date of service. If a reimbursement is due to you, a check will be mailed within 30 days of our receipt of your claim.

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18. How are diabetic supplies covered?
The Health Net pharmacy benefit covers insulin, lancets, needles, syringes and blood glucose test strips. Although these items are available over-the-counter, you must have a prescription for the pharmacy to process the claim.

Health Net's preferred brands are Accu-Chek® Aviva, Accu-Chek® Compact Plus, Freestyle Flash® and Freestyle Freedom®, and Precision Xtra monitors.

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19. What if I am on a medication that was covered by my previous health insurance?
Health Net's Continuity of Care Policy allows an initial 3-month coverage for a maintenance medication that was covered under a previous health insurance company but now requires prior authorization with Health Net. Continuity of Care request forms are available during enrollment or can be obtained from Customer Service at 1-800-289-2818. Please complete the Form and Fax to the number provided.

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20. How do I obtain a new Health Net ID card?
If you have not received or have lost your Health Net ID card, call Customer Service.

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If you have any other questions, contact Customer Service toll-free at 1-800-289-2818 or TTY/TTD at 1-800-977-6757. The Hours of Operation for both numbers is Monday through Friday, 7:00 a.m - 6:00 p.m. (GMT).

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