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Generally, the drugs available through mail order are drugs that you take on a regular basis for a chronic or long-term medical condition. Usually, you can expect to receive your drugs within days from the time the mail order service receives your order.
It is recommended that you contact the pharmacy 21 days before your current prescription will run out. This will ensure your order is shipped to you in time. You may register for our preferred Mail Order Service one of the following ways:. Our preferred mail order service can give you peace of mind knowing you'll have the drugs you need — when you need them.
You can also get status alerts by email, phone, or text. Once we receive the coverage determination request, it is reviewed to determine if it meets the requirements for approval. We must make our decision regarding an exception or prior authorization request and respond no later than 72 hours 24 hours for Medi-Cal covered drugs after we have received the prescriber's supporting statement.
Our response to the request will explain if the drug is approved to be covered. If we deny the request, members can appeal our decision. Information on how to file an appeal is included with the denial notification.
If waiting up to 72 hours for a "standard" decision could seriously harm the member's health or their ability to function, members or their prescribers can ask us to make a "fast" decision.
A fast decision is sometimes called an expedited coverage determination and applies only to requests for Part D drugs that members have not already received.
If a request for a fast decision is received, we must make our decision and respond within 24 hours. Requests for a fast decision can be made by fax or by calling Customer Service. We will make our decision and respond to all requests as quickly as the member's health condition requires. Calls received after hours will be handled by our automated phone system and a Health Net representative will return the call on the next business day.
To protect personal health information and privacy, please do not send emails to Health Net using a personal email account. Health Net has a Secure Messaging Center to make corresponding with us safe and efficient. To access Secure Messaging, you must be registered on HealthNet. For more information about coverage determinations, exceptions and prior authorization, refer to the plan's coverage documents or call Customer Service. The fact that a drug is listed on the formulary does not guarantee that it will be prescribed for a particular medical condition.
Overview Need quick access to our drug lists and pharmacy forms? Log In. Pharmacist Resource Center Our Pharmacist Resource Center links pharmacists to important information about our prescription drug plans and our latest pharmacy updates.
Prior authorization required Prior Authorization for Commercial Plans Prior Authorization for State Health Programs Prior Authorization Medicare Plans Drug lists Our formularies or drug lists include covered drugs that are selected by Health Net pharmacists, along with a team of health care providers.
Member drug list lookup Need to see a particular member's drug list? Drug information for commercial plans Individual, family and group drug lists Our drug lists are selected by Health Net, along with a team of health care providers.
Drug information for California state health programs Our drug lists or formularies include a comprehensive list of covered drugs selected by Health Net, along with a team of health care providers. Prior authorization for Commercial plans For some drugs, your doctor must get approval from us before you fill your prescription.
View Our Prior Authorization Guidelines Once we receive the request, we will review it to see if it can be approved. Prior authorization for State Health programs Your pharmacy benefit is administered by Medi-Cal Rx, and they are responsible for your authorizations.
Web : Medi-Cal Rx Fax: Coverage determinations for drugs — exceptions and prior authorization If a prescription drug is not covered, or there are coverage restrictions or limits on a drug, members or providers may request a coverage determination. Exceptions Members or providers can request a coverage determination to make an exception to our coverage rules.
An exception can be requested to: Cover a drug even if it is not on our formulary. Please note that if we grant a request to cover a drug that is not on our formulary, the drug will be available for the non-preferred brand tier copayment.
The drug is not eligible for an exception for payment at a lower tier. Waive coverage restrictions or limits on a drug. For example, Health Net may limit the amount of a drug that will be covered. If a drug has a quantity limit, members can ask us to waive the limit and cover more. Cover a drug at a lower tier. Drugs on the preferred brand tier and Specialty tier may not be eligible for an exception for payment at a lower tier. Prior authorization - Pharmacy Some drugs require prior authorization.
View A List Of Drugs Subject To Prior Authorization Coverage determination process To request an exception or to obtain prior authorization, members or prescribers can email, fax or mail a coverage determination request to the contact information listed below. Contact information Phone Prescribers: Calls received after hours will be handled by our automated phone system and a Health Net representative will return the call on the next business day. Email To protect personal health information and privacy, please do not send emails to Health Net using a personal email account.
Log in to the Secure Messaging Center.