The Health Net Drug List: A Formulary Q & A

When your doctor prescribes medicine, you're bound to have questions. You might ask about dosage, whether to take it with food, possible side effects, etc. And you'd want to know if the medication is covered by your Blue & Gold HMO plan from Health Net of California, Inc. (Health Net). We've put together the most common questions and answers about prescription drug coverage.

Q: What medications are covered by Health Net Blue & Gold HMO?
A: All drugs on the Health Net Recommended Drug List are covered. Each of the drugs on the list has been selected by a team of health care providers and Health Net based on their expert assessment of safety and effectiveness.

Q: What is the difference between the drug list and a formulary?
A: Nothing. A drug list is also referred to as a formulary.

Q: How can I review the Health Net Recommended Drug List?
A: A copy is posted online. Visit > View My Blue & Gold Benefits > Pharmacy.

Q: What drugs get selected for the list?
A: A drug is placed on the Health Net drug list if it is believed to be a necessary part of a quality treatment program. We don't exclude a drug based on cost unless there is an equally effective generic equivalent.

Q: How often is the drug list updated?
A: Health Net updates our drug list regularly.

Q: What if I'm prescribed medicine that is not on the drug list?
A: If your doctor prescribes medication that is not on the list, you can ask him or her to prescribe one that is on the list. Or your doctor can call Health Net to request approval for a drug not on the list and that is not excluded from coverage. These are called nonpreferred or non-formulary drugs. If Health Net approves an exception for a drug that is not on the Recommended Drug List, the non-preferred copayment applies.