Coverage Explanation

Provider Type

  • Physicians
  • Participating Physician Groups (PPG)

Health Net's prescription drug program is an option that provides members with prescription medication coverage. The member receives the highest benefit level when a Health Net PPO participating provider prescribes prescription medication on the Health Net Recommended Drug List (RDL) and the prescription order is filled by a participating pharmacy.

Most members have a multi-tier pharmacy benefit design. Tier I medications are primarily preferred generic medications and Tier II medications are primarily preferred brand-name medications. Tier III medications are primarily prescription medications specifically listed as Tier III medications or medications not listed on the Health Net RDL that are not excluded or limited from coverage. Some medications may require prior authorization by Health Net to be covered.