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Plan Details

Plan Documents

Download the PDF for your records or you can call 1-800-522-0088 to request a printed copy to be mailed to you.

Summary of Benefits and Coverage

Northern California

Southern California

Pharmacy Benefits

Health Net plans give you generic, brand and specialty tier coverage. The easy-to-use pharmacy programs offer the convenience you want with the value you're looking for.

To determine the cost of a drug, use the formulary list below to identify the drug and the tier under which it is covered. Below are the copays by tier for each of the plans available. To view detailed cost information of a drug by plan option, please click on the Check Drug Cost & Coverage links under the second column below.

Retail Prescription Drug Options
Retail prescription drugsGeneric/brand/non-formulary/specialty
High Option$10/$35/$60/20% ($200 max)
Check Drug Cost & Coverage
Standard Option (Southern CA) $15/$35/$65/20% ($200 max)
Check Drug Cost & Coverage
Basic Option (Southern CA)$15/$35/$65/20%
Check Drug Cost & Coverage
Mail Order Prescription Drug Options
Mail order prescription drugsGeneric/brand/non-formulary
High Option$20/$70/$120
Standard Option (Southern CA) $30/$70/$130
Basic Option (Southern CA)$30/$70/$130

Our drug lists are selected by Health Net, along with a team of health care providers. These drugs are included because they are believed to be a key part of a quality treatment program. The drug lists are updated regularly and may change.

Commercial Drug List

3-Tier with specialty drug list (PDF)

Other Information