List of Drugs (Formulary) |
List of Drugs (Formulary)
Our list of drugs (formulary) shows the Part D drugs that we cover. In general, we cover your drugs if they are medically necessary. Drugs on our list of drugs are covered when you use our network pharmacies or mail order program for maintenance drugs. Maintenance drugs are drugs you take for a chronic or long-term condition. Some drugs we cover have limits or other rules.
The Pharmacy and Therapeutics Committee, our team of independent healthcare experts, reviews and approves our list of drugs. We don’t include all drugs. Some drugs may not be covered or are excluded. Other drugs are not on the list because of clinical and cost reasons.
How Do I Search for a Drug in the List of Drugs (Formulary)?
You can search for a drug by using either the drug search tool or by opening a PDF document. Each option gives you a complete list of covered drugs and any restrictions or limits. The search tool also shows you covered drug alternatives.
The PDF document lists drugs by medical condition and alphabetically within the index. To search for your drug in the PDF, hold down the “Control” (Ctrl) and “F” keys. When the search box appears, type the name of your drug. Press the “Enter” key. You also have the option to print the PDF drug list. The drug list is updated monthly.
Plans for List of Drugs – A
- Health Net Healthy Heart (HMO)
- Health Net Ruby (HMO)
- Health Net Ruby Select (HMO)
- Health Net Sapphire (HMO)
- Health Net Gold Select (HMO)
- Health Net Jade (HMO C-SNP)
Plans for List of Drugs – B
- Health Net Amber I (HMO D-SNP)
- Health Net Amber II (HMO D-SNP)
- Health Net Amber II Premier (HMO D-SNP)
- Health Net Sapphire Premier (HMO)
- Health Net Sapphire Premier II (HMO)
You can ask us to make an exception to our rules for your drug(s). To learn how, read your Evidence of Coverage. When asking for an exception, include a statement from your doctor that supports your request, plus a completed Coverage Determination form.
Generally, we must decide on your request within 72 hours after we get your doctor’s statement. You can ask for a fast (expedited) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 72 hours. If we approve your expedited request, we must give you a decision within 24 hours after we get your doctor’s statement.
List of Drugs Change Notice
Drugs may be added or removed from our list of drugs during the year. Generally, we will tell you before the following changes are made to the list of drugs:
- Remove a drug from the list.
- Change drug requirements.
- Move a drug to a higher cost sharing tier.
If the Food and Drug Administration (FDA) or the drug’s maker says a drug is not safe, it will be removed from our list of drugs right away. In addition, if a new generic drug comes to market, we may remove the brand name drug.