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4-Tier Pharmacy Benefit
Health Net offers a prescription program with comprehensive drug coverage. Drug coverage is limited to drugs listed on this Drug List. The Drug List was developed by the Pharmacy and Therapeutics Committee, with involvement and recommendations from physicians, pharmacists, and other health care professionals. In addition to clinical considerations, the Committee evaluates the treatment costs of therapeutically equivalent pharmaceuticals. Development and maintenance of the Drug List is a dynamic process. The Drug List is continually reviewed and revised in response to recommendations from participating physicians and as new clinical data and pharmaceuticals become available.
The Drug List only applies to outpatient prescription drugs. It does not apply to inpatient drugs (hospital, skilled nursing facility or nursing home) or to drugs obtained from and/or administered by a health care professional.
Health Net's FlexRx 4-Tier Pharmacy Benefit is designed to provide flexibility and choice by allowing patients to work with their physicians to determine the most cost-effective drug therapy that meets individual needs. This benefit offers comprehensive drug coverage by covering generic and brand name drugs at four different copay levels. All drugs covered by the 4-Tier pharmacy benefit are assigned to one of the following tiers:
Tier 1: Drugs included in Tier 1 are available for the lowest copayment and include:
Tier 2: Drugs included in Tier 2 are available for a moderate copayment and include:
Tier 3: Drugs included in Tier 3 are available for a higher copayment and include:
Tier 4: Drugs included in Tier 4 are available for the highest copayment and include:
For more information regarding your pharmacy benefit, contact Health Net Customer Service at 1-800-289-2818. The TTY Customer Service number for the hearing impaired is 1-800-977-6757.