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.
For Individual, Family and Group Plan Members
This page contains the forms and instructions you'll need for the Prior Authorization process. Consult your Evidence of Coverage or Certificate of Insurance ("Plan Documents") for specific coverages and limitations.
Certain covered drugs require prior authorization. This means your physician must have Health Net's pharmacy specialists review the prescription and approve it to obtain coverage. The prior authorization process help ensure that you are receiving the medication with the best health and financial value for your medical condition.
The Prior Authorization process helps ensure that members have access to medications when medically necessary and a covered medication is not the best choice. These requests are referred to as Exceptions to the Drug Formulary, or Prior Authorization Requests.
To request an exception, your physician must print and complete the appropriate Health Net Pharmacy Prior Authorization form listed below and fax it to the number located on the form.
Commercial and Medicare Members: 1-818-676-8086
Medi-Cal Members: 1-800-977-8226
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 as outlined under the Appeals & Grievance process.
If you have any questions regarding the prior authorization process, contact Health Net at the Customer Service number located on your ID card.