23-1184 Let Members Know Their Pharmacy Benefit Manager is Changing to Express Scripts
Date: 10/16/23
The change only affects members with Medicare plans or on/off-exchange Ambetter plans.
Effective January 1, 2024, Express Scripts® will begin processing pharmacy claims for Health Net and Wellcare By Health Net (Health Net) members on the plans listed below. Note the exception for Retiree Drug Subsidy plans, which will remain with CVS in 2024:
Line of business/Product | Current pharmacy benefit manager | Pharmacy benefit manager as of January 1, 2024 |
|---|---|---|
On/off-exchange Ambetter HMO | CVS | Express Scripts |
On/off-exchange Ambetter PPO | ||
Wellcare By Health Net (Medicare) | ||
Employer Group Waiver Plan (Medicare) | ||
Dual Special Needs Plan (D-SNP) | ||
Retiree Drug Subsidy (RDS) (Medicare) | CVS | CVS |
How this affects members
Members have been notified in advance of this change.
Members can get their prescriptions filled at participating network pharmacies. A list is available at healthnet website.
Members will receive a new identification (ID) card showing updated pharmacy information. Members will need to use their new ID card to get prescription drugs beginning on January 1, 2024. Members must show their new ID card to the pharmacy to ensure the pharmacy sends the claim to the correct claims processor.
Mail order service on or after January 1, 2024
The prescribing physician can fax requests for new prescriptions to Express Scripts Pharmacy at 800-837-0959 or e-prescribe the request to Express Scripts Pharmacy.
Members can request mail order service for prescription medications and refills from Express Scripts Pharmacy by phone, mail or online.
Questions?
Physicians and other providers can refer members to the member services number listed on their ID card for any questions about this change.
If you have questions, please contact your Provider Relations Representative.
Additional information
Relevant sections of Health Net’s provider operations manuals will be revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library on Health Net’s provider portal > Provider Library under Quick Links, or go directly to provider library.
If you have questions regarding the information contained in this update, contact the applicable Health Net Provider Services Center at:
Line of Business | Phone number | Email address |
|---|---|---|
IFP Ambetter PPO | ||
IFP Ambetter HMO | ||
Health Net Employer Group HMO, POS, HSP, PPO, & EPO | ||
Medicare (Individual & Employer Group) |
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.