The subscriber number can be found on your Health Net Insurance card. Please enter the complete ID, including all letters and numbers. All letters must be typed as capital letters.
This page contains the forms and instructions you'll need for the Prior Authorization process. Consult your plan's Coverage Document for specific coverages and limitations.
If your medication has a comment on the Drug List indicating that it requires Prior Authorization (PA), Health Net recommends that you talk with your physician or medical provider as soon as possible about the prescribed medication and the alternatives available. If your physician decides to request prior authorization, we need to obtain information directly from your physician (this information may not come from the patient).
The prior authorization process helps ensure that you are receiving the medication with the best health and financial value for your medical condition.
These requests are referred to as Exceptions to the Drug List or Prior Authorization requests. Medical Directors provide physician oversight to this process, review recommended denials, and consult on requests as needed.
Your physician completes the Health Net
Prior Authorization/Medication Exception Request Form
and faxes it to:
If your physician does not have a fax machine, requests may be mailed to:
Health Net Pharmacy Services
5255 E. Williams Circle, Suite 4000
Tucson, AZ 85711
Upon receipt by Health Net, your prior authorization or exception request will be evaluated to determine if it meets standard approval criteria established by the Health Net Pharmacy and Therapeutics Committee. In this determination, we explain whether we will provide the prescription drug you are requesting, or pay for a drug you have already received. If we deny your request (this may be considered an adverse coverage determination), you can appeal our decision.
You should contact Health Net at the phone number located on your Health Net Member ID Card. Physicians should call 1-800-410-6565.
* Not applicable to Medicare Part D