Show your Health Net ID card at the pharmacy every time you get a prescription drug.

Search the Pharmacy Locator to find a network pharmacy or call Customer Service.

When you have a prescription to fill, keep the following tips in mind:

• Ask your doctor to prescribe generic drugs on our drug list.
• If your drug is not available as a generic, or is non-preferred, ask your doctor to prescribe a brand-name drug on our drug list.
• Take your drug list with you to doctor appointments.
• Tell your doctor that you want to pay the lowest copayment possible for your drugs.

Some drugs require prior authorization. This means that you must receive approval from Health Net before the drug will be covered. The prior authorization process ensures you are receiving the correct drug combined with the best value for your medical condition.

If your drug requires prior authorization, talk to your doctor about other drugs for your condition that are on our drug list. If there are no other drugs, your doctor may request prior authorization for your drug from Health Net.

For certain drugs, Health Net limits the amount of the drug that Health Net will cover. If your drug has a quantity limit, your doctor must request prior authorization for a higher amount.

Yes! If your prescription is due while you�re on vacation, an early refill can be made if you or your pharmacy notifies Health Net. You will be responsible for any additional copayment that may apply and will be limited to one additional month. If you need more than one month of refill, please use our mail order program (linked) to receive up to a three-month supply.

Yes. Our mail order program (linked) is generally used for maintenance medications.

Our drug lists are updated frequently. If your drug is not on our drug list, call Customer Service and ask if your drug is covered.

A compounded prescription is a medication that needs to be made by the pharmacist because the manufacturer does not make it in the prescribed strength or with the prescribed ingredients. These prescriptions may require prior authorization. Please call Customer Service for questions about compounded medications.

Our formulary or drug list is a list of covered drugs selected by Health Net, along with a team of health care providers. These drugs are selected because they are believed to be a necessary part of a quality treatment program. Health Net covers both brand name and generic drugs. Our formulary is updated regularly, so make sure to look up your prescriptions before you choose a plan. There is no guarantee that any specific drug included on the formulary will be prescribed for a particular medical condition

If you have paid out-of-pocket for a drug, you may be eligible for reimbursement (minus your copay) on prescriptions filled for emergency medical care.

Complete the Prescription Drug Claim Form and mail it with a copy of your detailed prescription receipts (not cash register receipts) to the address located on the form.

Claims must be submitted within one year of the date of service. If reimbursement is due to you, a check will be mailed within 30 days from when we received your claim.

AZ members:
Mail a copy of your prescription receipts (not cash register receipts) together with the member's name, Health Net ID number and daytime phone number to:
Health Net of Arizona
Attn: Pharmacy Dept.
5255 E. Williams Circle Suite 4000
Tucson, AZ 85711
Claims must be submitted within one year of the date of service. If a reimbursement is due to you, a check will be mailed within 30 days of our receipt of your claim.

OR & WA members:
Mail a copy of your prescription receipts (not cash register receipts) together with the member's name, Health Net ID number and daytime phone number to:
Health Net of Oregon
Attn: Pharmacy Claims
P.O. Box 10350
Van Nuys, CA 91410-0350
Claims must be submitted within one year of the date of service. If a reimbursement is due to you, a check will be mailed within 30 days of our receipt of your claim.

The Health Net pharmacy benefit covers insulin, lancets, needles, syringes, and blood glucose test strips. Although these items are available over-the-counter, you must have a prescription in order for the pharmacy to process the claim.

A generic drug is the same as a brand-name drug in:

• Dosage, strength, safety, quality.
• The way it works.
• The way it is taken.
• The way it should be used.

Yes. The FDA mandates that all drugs must be safe and effective. Generic equivalent drugs use the same active ingredients as brand-name drugs and work the same way. Therefore, they have the same risks and benefits as brand-name drugs.

Yes. Unless specifically told not to do so by you or your physician, pharmacies that contract with Health Net may substitute a generic drug for a brand-name drug. You should let your Pharmacists know if you want a generic equivalent.

Yes. The FDA mandates that all drugs must be safe and effective. Generic equivalent drugs use the same active ingredients as brand-name drugs and work the same way. Therefore, they have the same risks and benefits as brand-name drugs.

Yes. Unless specifically told not to do so by you or your physician, pharmacies that contract with Health Net may substitute a generic drug for a brand-name drug. You should let your Pharmacists know if you want a generic equivalent.

Yes. FDA requires that generic drugs be as high quality, strong, pure, and as stable as brand-name drugs.

No. Generic equivalent drugs work in the same way and in the same amount of time as brand-name drugs.

Yes. Generic equivalent drugs will behave in the same manner as brand-name drugs with the same interactions. Make sure to discuss all the medications you take with your physician, pharmacist or other health care professional to ensure you have no adverse reactions.

Also, by choosing a generic equivalent, you can save money through a lower copayment without compromising quality.

No. All factories must meet the same high standards. If the factories do not meet certain standards, the FDA will not allow their drugs to be sold in the U.S.

In the U.S., trademark laws do not allow generic drugs to look exactly like the brand-name drug. Generic drugs are inspected by the FDA and must have the same active ingredients. Colors, flavors, and certain other ingredients may be different, but these differences should not affect the way the drug works.

Ask your physician if a generic drug if there is a generic equivalent drug that will be right for you.

No. When new drugs are first made they are patented. Most drug patents are protected for 17 years. The patent protects the company that originally made the drug. The patent does not allow another manufacturer to make and sell the drug. When the patent expires, other drug companies can start selling the generic version of the drug, but they must first test the generic version of the drug and the FDA must approve it.

Developing a new drug is very expensive. Since generic drug makers do not develop a drug from scratch, the costs to bring the drug to market are less. Generic manufacturers, however, must show that their product performs in the same way as the brand-name drug. The FDA approves all generic drugs before they are released to the public.

Generic drugs are proven to be safe, effective and typically cost much less than brand-name drugs. By choosing generic drugs, you can save money without compromising quality.

Everyone benefits from affordable health care, but we each must do our part to keep costs low. Using generic equivalents and generic alternatives whenever possible is an easy way to help keep your benefits affordable and receive the same quality of care.

Get into the habit of asking your physician if a generic equivalent or a generic alternative is available each time you are prescribed a medication. Be sure to share this important information with your family and friends, and ask them to do the same with you.

Immediate Cost Savings: Generally, generic equivalents or alternatives cost less and are available at a lower copay than the similar brand-name drugs.

Long Term Cost Savings: Choosing generic drugs helps keep health care costs lower for Health Net and our members, leaving valuable resources available for more critical needs.

Contact your physician, pharmacist or other health care professional for information on your generic drugs.

You can search our Medicare Part D Formularies on the Drug Lists page. When it comes to benefits and prescription drugs, we are constantly re-evaluating our customers� needs. We know which conditions are most likely to affect you and the drugs you are most likely to need. That's why we've taken such care to ensure that our prescription drug plan for Medicare offers coverage for so many commonly prescribed, brand name, and generic drugs.

If you learn that Health Net does not cover your drug, you have two options:

• You can talk to your prescriber about switching your prescription to a covered drug.
• You can ask Health Net to make an exception and cover your drug.

There are several types of coverage determinations and exceptions that you can request. For more information about coverage determinations and exceptions, visit our Coverage Determinations pages:

• Arizona
• California
• Oregon/Washington

View our Mail Order Overview page for general information about ordering your prescriptions by mail.

You can use the Health Net mail order pharmacy to fill prescriptions for most maintenance drugs that are on the Health Net Medicare Part D formulary. Some drugs may not be available through the mail order pharmacy. A maintenance drug is any prescription drug needed to treat a chronic or long-term condition.

When you order prescription drugs by mail, you may not order more than a 90-day supply of the drug at a time.

You are not required to use Health Net's mail order pharmacy to obtain an extended supply of your drugs. Instead, you have the option of using a retail pharmacy in Health Net's network to obtain an extended supply of your drugs. Some network retail pharmacies, however, will only dispense a maximum 30-day supply of drugs. To find out if your pharmacy will dispense an extended supply, check your pharmacy directory or ask your pharmacy.

Before you use an out-of-network pharmacy, contact Customer Service to check if there is a network pharmacy in the area where you can fill your prescription.

If you are traveling within the United States and territories and become ill, lose or run out of your prescription drugs, we will cover prescriptions that are filled at an out-of-network pharmacy. We cannot pay for any prescriptions that are filled by pharmacies outside of the United States and territories, even for a medical emergency.

Generally, we will cover your prescription at an out-of-network pharmacy if you cannot reasonably be expected to obtain your drugs at a network pharmacy and when such access is not routine. This may include:

• If you are unable to obtain a covered drug in a timely manner within our service area because there are no network pharmacies within a reasonable driving distance that provide service 24-hours a day, seven days a week.
• If you are trying to fill a prescription drug that is not regularly stocked at an accessible network retail or mail order pharmacy (including high cost and unique drugs).
• If you are getting a vaccine that is medically necessary but not covered by Medicare Part B or other covered drugs that are administered in your doctor's office.
• If you need a prescription filled that is related to care for a medical emergency or urgent care.
• If you are evacuated or otherwise displaced from your home because of a Federal disaster or other public health emergency declaration.
• If you go to an out-of-network pharmacy, you may have to pay the full cost of your?drug rather than paying just your copayment. You can ask us to reimburse you for our share of the cost by submitting a claim. You should submit a claim to us if you fill a prescription at an out-of-network pharmacy because any amount you pay will help you qualify for catastrophic coverage. To learn how to submit a paper claim, please refer to the paper claims process described below.

Generally, when you go to a network pharmacy your claim is automatically submitted to us by the pharmacy. However, if you go to an out-of-network pharmacy, the pharmacy may not be able to submit the claim directly to us and you will have to pay the full cost of your prescription and submit your claim and your prescription receipt to us. For more information on submitting a claim, visit our Claims Reimbursement pages:

• Arizona
• California
• Oregon/Washington

You have the right to make a complaint if you have concerns or problems related to your coverage or care. "Appeals" and "Grievances" are the two different types of complaints you can make. Which one you make depends on your situation. Appeals and grievances are discussed in the Evidence of Coverage. This information can be reviewed on our Appeals and Grievance pages:

• Arizona
• California
• Oregon/Washington

The Health Net Medicare Part D Transition Program allows eligible Health Net Medicare Part D members to receive a temporary supply of drugs to avoid disruption of therapy.