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Some covered drugs require prior authorization or have coverage restrictions or limits. This means that you must receive approval from Health Net before the drug will be covered. If your doctor or pharmacist tells you that a prescription drug is not covered, or has coverage restrictions or limits, your doctor may request prior authorization or an exception.

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 some drugs, we only cover a specific amount of the drug. If a drug has a quantity limit, your doctor must request prior authorization for a higher amount to be covered.

Yes. If your prescription is due while you're on vacation, we will cover an early refill once per year if you or your pharmacy lets us know. The refill is limited to a one month supply.

Our drug lists are updated frequently. If you can't find your drug on our drug list, always contact us and ask if your drug is covered.

A compounded drug is made by a pharmacist because the manufacturer does not make it in a certain strength or with certain ingredients. These prescriptions require prior authorization. Please contact us for questions about compounded drug coverage.

Our drug list, or formulary, 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. Our drug lists are updated regularly and are subject to change. There is no guarantee that any specific drug included on the drug list will be prescribed for a particular medical condition.

If you have paid out-of-pocket for a drug, you may be eligible for reimbursement on prescriptions filled for emergency medical care. Please contact us for questions about reimbursements.

Your 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 for the pharmacy to process the claim.

Generic Drugs

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 and the way it should be used.

Yes. The United States Food and Drug Administration (FDA) requires that all drugs are safe and effective. Generic equivalent drugs use the same active ingredients as brand name drugs and work the same way.

Yes. Network pharmacies may substitute a generic drug for a brand name drug if one is available. If the brand name drug is requested when a generic is available, your doctor must request prior authorization or an exception for it to be covered.

Yes. FDA requires generic drugs to be equal to brand name drugs in quality, strength, purity, and stability.

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

Yes. Generic drugs will act the same way as brand name drugs. Be sure to discuss all the drugs you take with your doctor or pharmacist to ensure you have no adverse reactions.

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

No. New brand name drugs have a patent when they are first made. Most drug patents are protected for several years. The patent protects the company that originally made the drug. The patent does not allow another drug company to make and sell the drug. When the patent expires, other drug companies can start selling the generic version of the drug after it has been tested and approved by the FDA.

Developing a new drug is very expensive. Since generic drug companies do not develop a drug from scratch, the costs to bring the drug to market are less. Generic drug companies, however, must show that their drug acts 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.

Talk to your doctor or pharmacist for more information about generic drugs.

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Last Updated: 08/29/2023