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Pharmacy Prior Authorization Guidelines

Coverage of drugs is first determined by the member's pharmacy or medical benefit. Please consult with or refer to the Evidence of Coverage or Certificate of Insurance document for a list of exclusions and limitations.

Drug Coverage Policies in Alphabetical Order


  • natl = Applies to all lines of business in all Health Net regions (CA, OR)
  • hnca = Applies only to Commercial plans (HMO, POS, PPO, EPO, Healthy Families, AIM)
  • hnmc = Applies only to Health Net Medi-Cal

Last Updated: 05/30/2024