Pharmacy and Generic Drugs FAQs
Some covered drugs require prior authorization or have coverage restrictions or limits. This means that you must receive approval from Health Net before the drug will be covered. If your doctor or pharmacist tells you that a prescription drug is not covered, or has coverage restrictions or limits, your doctor may request prior authorization or an exception.
If your drug requires prior authorization, talk to your doctor about other drugs for your condition that are on our drug list. If there are no other drugs, your doctor may request prior authorization for your drug from Health Net.
For some drugs, we only cover a specific amount of the drug. If a drug has a quantity limit, your doctor must request prior authorization for a higher amount to be covered.
Yes. If your prescription is due while you're on vacation, we will cover an early refill once per year if you or your pharmacy lets us know. The refill is limited to a one-month supply.
A compounded drug is made by a pharmacist because the manufacturer does not make it in a certain strength or with certain ingredients. These prescriptions require prior authorization. Please Contact Us for questions about compounded drug coverage.
Our drug list, or formulary, is a list of covered drugs selected by Health Net, along with a team of health care providers. These drugs are selected because they are believed to be a necessary part of a quality treatment program. Our drug lists are updated regularly and are subject to change. There is no guarantee that any specific drug included on the drug list will be prescribed for a particular medical condition.
Your pharmacy benefit covers insulin, lancets, needles, syringes, and blood glucose test strips. Although these items are available over-the-counter, you must have a prescription for the pharmacy to process the claim.
Generic Drugs FAQs
A generic drug is the same as a brand name drug in:
- Dosage, strength, safety, quality
- The way it works, and
- The way it is taken
For more information, download our Generic vs Brand-Name Drugs Information (PDF) flyer.
A generic equivalent is a drug that contains the same active ingredient as the brand name drug. For example, lisinopril is the generic equivalent of brand name drugs, Zestril® and Prinivil®.
A generic alternative is a generic drug that works in the same way as a brand name drug and treats the same condition. The drug lisinopril, for example, is a generic alternative to the brand name drug, Altace®. Both drugs lower blood pressure, but they do not contain the same exact active ingredients. Generic alternatives are equal to the brand name drug in safety and how well they work.
Yes. The United States Food and Drug Administration (FDA) requires that all drugs are safe and effective. Generic equivalent drugs use the same active ingredients as brand name drugs and work the same way.
Yes. Unless told not to do so, network pharmacies may give you a generic drug instead of a brand name drug.
Yes. FDA requires generic drugs to be equal to brand name drugs in quality and strength.
No. Generic drugs work in the same way as brand name drugs.
Yes. Generic drugs will act the same way as brand name drugs. Be sure to tell your doctor about all of the drugs you take.
No. The FDA says that all factories must meet the same high standards.
No. New brand name drugs have a patent when they are first made. The patent does not allow another drug company to make and sell the drug. Most drug patents last for several years. When the patent expires, other drug companies can start selling the generic version of the drug.
Making a new drug costs a lot. Since generic drug companies do not create a drug from scratch, the costs are less. Generic drug companies must prove that their drug acts in the same way as the brand name drug. The FDA approves all generic drugs before they are released to the public.
Generic drugs are proven to be safe and work well. By choosing generic drugs, you can also save money in most cases.