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 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 get 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.
If you need a medication that requires prior-authorization, the pharmacy can provide you with a 72-hour supply of the medication while waiting for the prior-authorization from Health Net.
Medical Directors provide physician oversight to this process and consult on requests as needed.
Prior Authorization and Exceptions Process
To request an exception, your physician must print and complete the Health Net Prior Authorization/Medication Exception Request Form and fax it to 1-800-977-8226.
If your physician does not have a fax machine, requests may be mailed to:
Prior Authorization ListsPrior Authorization Guidelines
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 already have 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.
You may contact the Customer Contact Center at the phone number located on your Health Net ID card.
If urgent, physicians should call: 1-800-867-6564.