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Prior Authorization

Some drugs require prior authorization. This means that members must receive approval from Health Net before a drug will be covered. 

For a list of services and medications that require prior authorization, call the customer contact center at the phone number listed on your Member ID card.

Step Therapy

In some cases, step therapy is required before we will cover a drug. This means that members must try one drug before we will cover another drug for the same medical condition.

Example: If Drug A and Drug B both treat the same medical condition, we may not cover Drug B unless the member tries Drug A first. If Drug A does not work, we will then cover Drug B.

In the example above, if the member’s recent claims history shows use of Drug A, we will cover Drug B.

Health Net may override a step therapy requirement for some reasons. To ask for an override to a step therapy requirement, the prescriber must complete a Prior Authorization Request Form (PDF) and provide one of the below items:

  • A statement that the member tried and failed the step therapy drug(s)
  • Medical justification about why the step therapy drug(s) are not appropriate for the member

View our Provider Prior Authorization Guidelines for detailed information about our approval and step therapy criteria.