Prior Authorization

This page contains the forms and instructions you'll need for the Prior Authorization process. Consult your Prescription Benefits Supplemental Benefit Schedule for specific coverages and limitations.

If your medication has a comment on the Preferred 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 you).

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 Preferred Drug List or Prior Authorization requests. Medical Directors provide physician oversight to this process, review recommended denials, and consult on requests as needed.

Prior Authorization and Exceptions Procedure

Your physician should complete and fax the following Health Net prior authorization form to 1-800-255-9198:

If your physician does not have a fax machine, requests may be mailed to:

Health Net of Oregon
P.O. Box 10350
Van Nuys, CA 91410-0350

For urgent requests, your physician may call: 1-888-802-7001

Prior Authorization Lists

Prior Authorization Guidelines

Upon receipt by Health Net, your Prior Authorization/Medication 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. If you decide to purchase the medication without authorization, you will be responsible for the total cost of the medication unless otherwise noted on the Preferred Drug List.

You should contact Health Net at 1-888-802-7001 if you have any additional questions.

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