HealthNet health insurance includes prescription drug plans are offered by several of the HealthNet subsidiary companies. HealthNet also offers administrative services for self funded benefit programs and medical groups.
Members on maintenance medication can receive a 90-day supply delivered directly to their home or office by completing our mail order prescription drug form. Members must obtain an original prescription from your participating physician for a 90-day supply (plus refills up to the equivalent of one year) and include two
If an urgent medical condition or emergency situation arises and you need to have a prescription filled, you may need to pay for it out of pocket and seek reimbursement from Health Net by submitting a prescription claim form. Claim forms can be obtained by calling Member Services at 1-800-522-0088, using the Ordering Materials section on this web site or downloading a claim form by logging into the Member Services section of this website.
A brand name drug is a drug that has been given a brand name by its manufacturer. When a new drug is developed, the manufacturer applies for a patent, which also gives the manufacturer the right to name its product. Manufacturers of drugs pick unique, usually memorable names to promote product recognition.
Generic drugs are the pharmaceutical equivalent of brand name drugs whose patents have expired and are produced by multiple drug companies, usually at a lower cost. Generics are FDA-tested, and approved to meet the same standards of safety and effectiveness as their brand name versions.
When a medication requires prior authorization, safety steps are followed to ensure certain clinical criteria are met before medication is dispensed. First, your doctor must contact Health Net to provide information on the medical reasons for the medication. Upon receiving the necessary information, Health Net will assess this information based on established clinical criteria for the particular product. If the clinical criteria are met, an authorization will be issued for the medication.
If an member chooses to receive a drug for a covered benefit that is not on the Health Net Recommended Drug List, it will be dispensed for the non-formulary copayment. However, some drugs, for the safety of the member, require prior authorization.
The Health Net Recommended Drug List is developed and maintained by the Health Net Pharmacy and
Therapeutics (P&T) Committee. Before deciding whether to include a drug on the List, the committee reviews
medical literature and consults with specialists to assess drugs for the following:
