Prior Authorization

There are three options for submitting a prior authorization form:

1. Submit the prior authorization electronically through CoverMyMeds which is Health Net's preferred way to receive prior authorization requests.
2. Complete the Prescription Drug Prior Authorization or Step Therapy Exception Request Form (PDF) and submit to Pharmacy Services.
3. Contact Pharmacy Services directly via telephone.

When certain designated injectables are requested by a participating provider or participating physician group (PPG) with a shared-risk arrangement, prior authorization must be obtained through Pharmacy Services. This requirement also applies to PPGs with delegated utilization management. Self-injectable medications require prior authorization whenever Health Net has the risk.

The participating provider or PPG must complete the appropriate California State Prior Authorization Request form detailing the medical necessity and the duration of the requested medication.

For all provider portal needsefer to the Health Net provider secure website. 

The completed form must be faxed to Pharmacy Services. The participating provider or PPG may call Pharmacy Services directly for urgent requests.

The approval or request for additional information is faxed back to the original requestor as noted on the Prior Authorization Request form.

Upon approval, Pharmacy Services forwards the approved authorization to one of Health Net's participating specialty pharmacy providers. The specialty provider contacts the Health Net member to arrange for delivery. For additional information regarding injectable medications, refer to the Health Net Injectable Medications HCPCS/DOFR Crosswalk (PDF) table.