Immunizations and Injections
Immunizations and injections, professional services to inject the medications, and the medications that
are injected are covered as shown in "Schedule of Benefits and Copayments," Section 3. This includes allergy serum.
Member Physicians will provide immunizations that are recommended by guidelines published by the
Advisory Committee on Immunization Practices (ACIP) of the U.S. Public Health Service or the
American Academy of Pediatrics (AAP).
In addition, injectable medications (including Glucagon) approved by the FDA are covered for the
Medically Necessary treatment of medical conditions when prescribed by the Member’s Primary Care
Physician and authorized by Health Net.
Self-injectable Drugs (other than insulin), needles and syringes used with these self-injectable drugs
must be obtained through Health Net's contracted Specialty Pharmacy Vendor when Prior Authorization is obtained from Health Net. Upon approval, Health Net will arrange for the distribution of drugs, needles and syringes from the appropriate Specialty Pharmacy Vendor. The Specialty Pharmacy Vendor may contact you directly to coordinate the delivery of your medications.
The Specialty Pharmacy Vendor will charge you for the appropriate Copayment or Coinsurance shown in the separate Medicare Prescription Drug Plan Evidence of Coverage.
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