Does Health Net Cover TRT? What Its 2026 Policy and California Drug Lists Require

TRT Provider Guide · Last verified: November 2026 (sources checked November 10, 2026; Health Net's commercial testosterone policy CP.CPA.291 is printed with Last Review Date 11.26, and the California 4-tier and Ambetter from Health Net drug lists we opened are labeled Updated November 1, 2026) · Editorial research

Last updated: November 10, 2026.

TRT Provider Guide is the independent decision resource for testosterone replacement therapy — helping U.S. adults understand how low testosterone is evaluated, compare online and local care models and providers, and choose the next step that fits their health needs, fertility plans, budget, state, and care preferences, with every material claim verified and dated.

Affiliate disclosure: We may earn a commission if you use the tracked links to Male Excel or Hone on this page. That does not change the Health Net documents quoted below, and official Health Net, Centene, and FDA links are not affiliate links.

Educational notice: This page explains plan documents. It is not medical advice, it does not diagnose low testosterone, and it is not a guarantee that Health Net will approve or pay a claim.

The short answer

Answer capsule: Yes, commercial Health Net can cover TRT. Policy CP.CPA.291 requires primary or hypogonadotropic hypogonadism and testosterone below 300 ng/dL, or below the lab's range, on two separate days in six months. California's November 1, 2026 group 4-tier list places generic injections at Tier 1. Age-related hypogonadism is not authorized.

Being named in that policy is not the same as being on your drug list. Generic testosterone cypionate and enanthate are listed. Brand products the policy discusses, including Xyosted, Jatenzo, Kyzatrex, Natesto, Androderm, Aveed, and Testopel, do not appear by name on the California 4-tier list we opened. Unlisted drugs can be requested as exceptions. Office-administered testosterone is a separate medical-benefit prior authorization, effective October 1, 2026.

The right TRT provider is not the same for every person — it depends on whether low testosterone has been properly evaluated, your symptoms and health history, your fertility plans, your state, your insurance or cash-pay preference, your treatment-format preference, your budget, and whether online or in-person care is the better starting point. Some situations belong with primary care, urology, endocrinology, reproductive urology, or urgent or emergency care when the symptoms warrant it. Because a general answer cannot resolve those for you, use TRT Provider Guide's Find My TRT Path tool to map your situation to the right care route and the questions to ask before you pay.

Who this page is for, and who it is not for

Best for: adults on a commercial Health Net plan, especially Health Net of California large-group or small-group coverage, who want to know whether testosterone is covered, what prior authorization requires, and how the 2026 drug lists treat injections and gels.

Also useful for: California members whose card says Ambetter from Health Net; Health Net Health Plan of Oregon members comparing the Oregon Essential Drug List; and people deciding whether a cash-pay online program is a better fit after a denial or a missing local prescriber.

Not the right starting point if:

• You have Health Net Medicare Advantage, a Wellcare by Health Net Part D plan, or any other Medicare drug coverage. Those plans follow Medicare rules and different lists. Start with Does Medicare cover TRT?.
• You have Health Net Medi-Cal or another Medicaid product. Start with Does Medicaid cover TRT?. This page does not apply those rules, and the cash-pay programs below are not a fit for government-program coverage.
• Your card says Ambetter but you are not in California. Use Does Ambetter cover TRT?, which reviews official 2026 lists for other Ambetter states.
• You have Molina, which is a different Centene-affiliated payer with its own testosterone policy. Use Does Molina cover TRT?.

What does Health Net's commercial testosterone policy require?

Health Net hosts Clinical Policy CP.CPA.291, Testosterone as a commercial policy for health plans affiliated with Centene. The PDF we opened on November 10, 2026, is labeled Line of Business: Commercial, Effective Date 11.16.16, and Last Review Date 11.26. The revision log's 4Q 2026 annual review is dated July 9, 2026, with a P&T approval date listed as 11.26, and it states no significant changes.

The policy lists these products as testosterone agents requiring prior authorization: Jatenzo, Kyzatrex, Tlando, Undecatrex, Vogelxo, Testim, Androderm, Natesto, Testopel, Xyosted, Azmiro, and Aveed. Generic testosterone is also in the medically necessary list. That is the clinical rulebook. It is not, by itself, a promise that each of those brands is on your pharmacy list.

For a new adult hypogonadism request, the member must meet all of the following:

1. A diagnosis of primary hypogonadism or hypogonadotropic hypogonadism.
2. Age 18 or older, unless the request is for testosterone cypionate, testosterone enanthate, or Testopel.
3. Documentation of serum testosterone below 300 ng/dL, or less than the lab reference range, on at least two separate days within the last six months.
4. The product-specific step in the next section.
5. A dose that does not exceed the FDA-approved maximum in the policy's dosing table.

The policy also states, in Section III, that coverage is not authorized for age-related hypogonadism or late-onset hypogonadism. That lines up with the FDA limitation of use on testosterone labels, which we return to below.

The two-lab rule does not, in the hypogonadism text we opened, require that those draws be morning draws. Many other payers do require morning labs. This policy still needs two results on separate days in a six-month window, and your clinician may still order morning tests because that is how testosterone is usually evaluated. For how other plans write the cutoff, see What testosterone level qualifies for TRT?. That page already cites an earlier review of CP.CPA.291 in a multi-payer table; the numbers above come from the current Health Net-hosted PDF.

This page focuses on adult hypogonadism. The same policy has separate initial criteria for delayed puberty, certain breast cancers treated with intramuscular testosterone enanthate, and gender dysphoria. Those pathways have their own prescriber and documentation rules, and we do not walk them through here.

What step therapy does the policy apply?

The fourth initial-approval rule is product-specific:

• Generic testosterone cypionate or generic testosterone enanthate: no additional trial is required under this step.
• Testosterone cypionate (as a brand request), Xyosted, Aveed, or Azmiro: the member must use generic testosterone cypionate or generic testosterone enanthate, unless it is contraindicated or the member has had a clinically significant adverse effect.
• Testopel: medical justification must support the inability to use transdermal testosterone (patch or gel) and injectable testosterone.
• All other requests, including gels, patches, nasal gel, and oral capsules: the member must be 18 or older and must have failed generic testosterone transdermal gel at up to maximally indicated doses, unless it is contraindicated or caused a clinically significant adverse effect. The policy defines failure as total testosterone that stays lower than normal laboratory reference values.

That is why a generic injection request and a Xyosted or Kyzatrex request are not the same paperwork problem.

How long does a Health Net testosterone approval last?

For a new hypogonadism approval, CP.CPA.291 sets:

• Testopel: 6 months.
• Injectables: 6 months or to the member's renewal date, whichever is longer.
• All other agents: 12 months.

Adult continuation for those same indications requires that the member is currently receiving the medication through a Centene benefit, previously met initial approval criteria, or qualifies under a continuity-of-care rule; that the member is responding positively to therapy; and that any dose increase stays within the FDA maximum. Continuation approvals use the same duration split: Testopel 6 months, injectables 6 months or to the renewal date, whichever is longer, and all other agents 12 months.

The policy does not, in that adult continuation section, add a maximum testosterone result such as "renew only if total T is 800 ng/dL or less." Some other plans do. Delayed puberty is different: re-authorization is not permitted, and the member must meet the initial criteria again. If Health Net denies a request, use the steps in testosterone prior authorization.

What is on Health Net of California's 2026 group 4-tier list?

Health Net's California 4-tier formulary for large-group and small-group plans, labeled Updated November 1, 2026, is the list we used for employer coverage. Tier 1 is most generics and low-cost preferred brands. Tier 2 is non-preferred generics and preferred brands. Tier 3 is non-preferred brands. Tier 4 is specialty or drugs that cost the plan more than $600 net of rebates for a month. The list tells you to use your Evidence of Coverage for the dollar copay or coinsurance, so this page does not invent a Health Net copay amount.

In the androgens section, these are the testosterone rows we could read clearly:

Several generic gels are Tier 1 with quantity limits and no PA flag on the row. The 1% 50 mg/5 g presentation is the exception: it is still Tier 1, but it also has a prior-authorization flag. If that is the NDC your pharmacy types, do not assume it will fill like the other generic gel rows.

We searched this 4-tier list for Androderm, AndroGel, Aveed, Azmiro, Jatenzo, Kyzatrex, Natesto, Testim, Testopel, Tlando, Undecatrex, Vogelxo, and Xyosted. Those brand names do not appear. The list says that if a drug is not on the drug list and is not specifically excluded, your doctor can ask for an exception by submitting a prior-authorization request with a supporting statement. If Health Net approves an exception for a drug that is not on the list, the Tier 3 or Tier 4 copayment applies, and the approval lasts through the end of the plan year if you stay enrolled, your doctor keeps prescribing the drug, and the drug remains safe for your condition.

Health Net also posts 2-tier and 3-tier recommended commercial lists, plus an Aon Benefit Experience list. If your ID card or Evidence of Coverage points to one of those, use that list, not the 4-tier table above.

A January 1, 2027 update of the same 4-tier list is already posted. The testosterone rows we compared still follow the same pattern, including the PA flag on the 1% 50 mg/5 g gel. Lists change, so confirm the current file before you fill.

How is Ambetter from Health Net in California different?

California individual and family plans use a different document: the Ambetter from Health Net California drug list, also labeled Updated November 1, 2026. Customer Service on that list is 1-800-839-3366.

The injection pattern is close to the group 4-tier list: Depo-Testosterone and generic testosterone cypionate at Tier 1 with a 10 mL retail and 10 mL mail quantity limit, the capitalized 200 mg/mL cypionate row at Tier 2 with the same limits, and testosterone enanthate at Tier 1. Generic gels are generally Tier 1 with quantity limits. A generic testosterone solution row appears at Tier 1 with a 6 mL daily quantity limit. Methyltestosterone capsules are Tier 1 on this list, not Tier 4. Methitest tablets are still Tier 4.

Two differences matter at the pharmacy:

• Testim gel is listed at Tier 3 with a 10 g daily quantity limit and a prior-authorization flag. Testim is not named on the group 4-tier list we opened.
• The combined generic gel row that includes the 50 mg/5 g presentation does not carry a PA flag on the Ambetter list, unlike the separate 50 mg/5 g row on the group 4-tier list.

A January 1, 2027 update of the Ambetter from Health Net list is already posted. The Testim Tier 3 PA row is still there in the file we compared. If your card says Ambetter and you live outside California, go to Does Ambetter cover TRT? instead of using these California rows.

What about Health Net in Oregon?

Health Net Health Plan of Oregon posts an Essential Drug List dated October 1, 2026. It is not a copy of the California 4-tier list. Rows we could read clearly include Methitest at Tier 1, Depo-Testosterone 200 mg/mL at Tier 1, Depo-Testosterone 100 mg/mL and testosterone cypionate 100 mg/mL marked SP (the list's specialty copayment), testosterone cypionate 200 mg/mL at Tier 1, a capitalized TESTOSTERONE CYPIONATE 200 mg/mL row at Tier 3, AndroGel Pump gel at GP (generic preferred) with a 10 g daily quantity limit, generic testosterone gel at Tier 1 with a 10 g daily quantity limit, testosterone gel 10 mg/actuation at Tier 1 with a 4 g daily quantity limit, and testosterone solution at Tier 1 with a 6 mL daily quantity limit.

AndroGel Pump appearing on the Oregon list, and some 100 mg/mL cypionate presentations marked specialty, are differences you will not see on the California 4-tier androgens table. Oregon members should use the Oregon list and the number on their card, and should confirm whether CP.CPA.291 is the policy their plan applies.

We did not verify a current 2026 commercial testosterone list for Health Net in Arizona, so we do not describe Arizona coverage here.

Does office-administered testosterone need a different authorization?

Yes. Health Net of California's commercial prior authorization requirements, effective October 1, 2026, include "Testosterone therapy" under outpatient pharmaceuticals submitted under the medical benefit, authorized by Pharmacy Services. That list applies to Direct Network HMO, including Ambetter HMO, POS tiers, Ambetter HMO participating physician groups, and PPO, including Ambetter PPO and out-of-state PPO.

The 4-tier formulary's medical-benefit section says drugs that are not considered self-injectable and are administered by your doctor are covered under the medical benefit. Pellets, Aveed, and clinic-injected testosterone often land here even when a similar product also exists on a pharmacy list. Ask the clinic whether they bill the drug as pharmacy or medical, then follow that path. Cash-pay pellet ranges are on testosterone pellets cost. Aveed cash-pay context is on Aveed cost.

How do I submit a Health Net testosterone prior authorization?

For pharmacy requests, the California 4-tier list says requests may be submitted electronically through CoverMyMeds, by phone at 1-800-548-5524, or by fax at 1-800-314-6223. Health Net says it will notify the doctor of a decision within 72 hours. If it fails to respond to a completed prior-authorization or step-therapy exception request within 72 hours for a non-urgent request, or within 24 hours for a request based on exigent circumstances, the request is deemed approved and the plan may not deny it later. If the doctor believes waiting 72 hours could seriously harm the member's health, the doctor can ask for an expedited decision, which the list says must be made within 24 hours after Health Net receives the supporting statement. That expedited path applies to drugs the member has not already received.

Your doctor has to send a supporting statement that explains why you need the drug. If the request is denied, you or your doctor may appeal. Denial documents explain those rights.

Bring this to the visit:

• The exact product, strength, and NDC the pharmacy will bill.
• Two testosterone results from separate days in the last six months, with the lab's reference range visible.
• A diagnosis of primary or hypogonadotropic hypogonadism, not a shorthand for age-related low testosterone.
• For a brand injection, documentation of why generic cypionate or enanthate cannot be used.
• For a gel, patch, nasal gel, or oral capsule, documentation that generic testosterone gel was tried at a full dose, was contraindicated, or caused a significant adverse effect, unless the request is already for a generic injection.
• For Testopel, documentation that both transdermal and injectable testosterone cannot be used.

Can you use Health Net with an online TRT clinic?

Only if the clinic is in network, will bill Health Net, and will submit the prior authorization. Most online TRT programs are cash-pay and will not do that work.

The two programs we list first on this site both work outside Health Net:

• Male Excel says on its pricing page that it does not accept insurance and that treatment is self-pay. Its published pricing, checked November 10, 2026, shows a $99 one-time at-home hormone test and consultation, a required Proactive Healthcare Membership of $99 a month paid monthly or $79 a month on an annual plan paid upfront, and medication billed separately. Its pricing FAQ puts common starting-dose medication options at $95 to $132 a month. The same FAQ lists nine states where it does not prescribe hormone treatment: Alaska, Arkansas, Connecticut, Hawaii, Idaho, Louisiana, Mississippi, New Hampshire, and Rhode Island. California and Oregon are not on that exclusion list.
• Hone says in its help center that it does not accept insurance and, as a cash-pay service, does not complete prior authorizations. Its membership overview, updated September 29, 2026, lists the men's TRT Plus plan at $135 a month and Premium at $155 a month, with medication billed separately. Confirm that your state is served before you enroll.

Neither one will send a Health Net claim or submit a Health Net prior authorization for you. Both say HSA or FSA funds may be usable depending on your plan administrator. Details are on our TRT providers that accept HSA or FSA and Does Male Excel accept insurance? pages.

When does cash pay make more sense than Health Net coverage?

We cannot quote a Health Net generic copay here, because the 4-tier list points you to the Evidence of Coverage for dollar cost-sharing, and that amount varies by group and plan. If your approved generic fill is a standard Tier 1 copay, insurance will usually cost less than a cash-pay program over a year. Ask Health Net for an estimate on the exact product before you compare.

A year with Male Excel at $99 a month plus $95 to $132 a month in medication, plus the $99 start, runs roughly $2,400 to $2,900 before shipping. That is the published cash-pay side of the comparison, not a Health Net copay.

Cash pay can still be the better fit when:

• Health Net denied the request, or you cannot get two qualifying lab results on file, and you want a clinician to evaluate you while you sort that out.
• You do not have a local prescriber who will manage testosterone and handle the prior authorization.
• You want structured follow-up and lab scheduling run by one program, and you accept paying for it.
• You need a brand or compounded product that is missing from your list, and you do not want to wait on an exception.

If that is you, compare Male Excel's published program first, then Hone. Neither one makes Health Net pay for the visit or the medication. If you are not sure which route fits, Find My TRT Path asks about your coverage, state, fertility plans, and format preference first.

See Male Excel's published cash-pay program

See Hone's published program

How do I check my own Health Net testosterone coverage?

1. Confirm the product on your card: commercial Health Net of California, Ambetter from Health Net in California, Health Net Health Plan of Oregon, or another Health Net plan. Do not use this page for Medicare or Medi-Cal.
2. Open the drug list that matches that product. For California large or small group, start with the current 4-tier list at healthnet.com. For California individual and family Ambetter plans, use the Ambetter from Health Net list. For Oregon, use the Oregon Essential Drug List. The lists are updated at least monthly.
3. Write down the tier and every flag: PA, QL, ST, SP, GP, or LA.
4. If your product is not listed, ask whether it is excluded or whether your doctor should request an exception.
5. Ask your clinic whether the drug will be billed under pharmacy or the medical benefit. Medical-benefit testosterone therapy has its own authorization path.
6. Ask your prescriber who will submit the prior authorization and which two lab reports they will attach.
7. Call the number on your card, or the customer-service number printed on your list, for a cost estimate on the exact NDC, then add visit and lab costs from your Evidence of Coverage.
8. If Health Net denies the request, get the reason in writing and follow testosterone prior authorization.

California members choosing 2027 coverage can already open the January 1, 2027 4-tier and Ambetter from Health Net lists. Use those files for a 2027 plan, then re-check at fill time.

What should you settle with your doctor first?

A coverage decision is not a diagnosis. Testosterone is a Schedule III controlled substance, and it needs a real evaluation, follow-up labs, and monitoring.

• Fertility: testosterone can lower sperm production, and that effect may not fully reverse. If you want children now or later, say so before anyone sends a prior-authorization request. See Does TRT affect fertility?.
• Blood pressure and heart health: In February 2025, FDA required class-wide labeling changes for testosterone products. FDA said labels should add the TRAVERSE cardiovascular safety trial results, keep the limitation of use for age-related hypogonadism, and remove Boxed Warning language about an increased risk of adverse cardiovascular outcomes. It also required blood-pressure warnings: product-specific data where ambulatory blood pressure studies were done, and a new increased-blood-pressure warning for products that lacked one. See TRT and blood pressure.
• Age-related low testosterone: FDA labels keep a limitation of use for age-related hypogonadism, and CP.CPA.291 says coverage is not authorized for age-related or late-onset hypogonadism.
• Gels: topical testosterone carries a boxed warning about secondary exposure, where transferred gel can affect children and women.

This page does not tell you to start, stop, or change testosterone, and it does not interpret your labs. Review the current label for your exact product with a clinician. More background is on FDA-approved testosterone products.

What we actually verified

Verified on November 10, 2026:

• Health Net-hosted commercial policy CP.CPA.291, Testosterone, printed Last Review Date 11.26: initial hypogonadism criteria, step-therapy rules, approval durations, continuation rules, and the age-related hypogonadism exclusion. The 4Q 2026 annual review in the revision log is dated July 9, 2026, with a P&T approval date listed as 11.26, and states no significant changes.
• Health Net of California 4-tier formulary for large and small group, updated November 1, 2026: androgen rows, tier definitions, unlisted-drug exception rules, prior-authorization turnaround times and phone/fax numbers, and the medical-benefit description.
• The January 1, 2027 update of that 4-tier list: the same testosterone pattern, including the PA flag on the 1% 50 mg/5 g gel row.
• Ambetter from Health Net California drug list, updated November 1, 2026, and its January 1, 2027 update: injection, gel, Testim, and methyltestosterone rows.
• Health Net Health Plan of Oregon Essential Drug List, dated October 1, 2026: the androgen rows described above.
• Health Net of California commercial prior-authorization requirements, effective October 1, 2026: "Testosterone therapy" under medical-benefit outpatient pharmaceuticals, including Ambetter HMO and PPO lines on that list.
• Male Excel's public pricing page, checked November 10, 2026, and Hone's public help-center membership and insurance articles (updated September 29, 2026, and September 4, 2026).

What we could not confirm: the dollar copay or coinsurance for any one Health Net group or individual plan; whether every Health Net commercial product, including Oregon, uses CP.CPA.291 without a state addendum; a current 2026 Health Net Arizona commercial testosterone list; and whether a specific NDC that is missing from a list is excluded or only omitted.

What we did not do: examine anyone, read anyone's labs, submit a Health Net claim, or enroll with a provider. A clinician has not reviewed this page. Our process is described in How we review providers.

Health Net and TRT: frequently asked questions

Does Health Net cover TRT?

It can, on commercial plans. CP.CPA.291 allows coverage for documented primary or hypogonadotropic hypogonadism when the lab and product rules are met. Your drug list still has to cover the product, or your doctor has to get an exception. This answer does not apply to Health Net Medicare or Medi-Cal.

Does Health Net cover testosterone injections?

Yes, on the lists we opened. The California 4-tier list, updated November 1, 2026, places generic testosterone cypionate and testosterone enanthate at Tier 1, with a 10 mL retail quantity limit on the cypionate rows. CP.CPA.291 does not require a gel trial first for generic cypionate or enanthate. Injectable approvals last 6 months or to the member's renewal date, whichever is longer.

Does Health Net cover testosterone gel?

Generic gels appear at Tier 1 on the California 4-tier list, usually with monthly or daily quantity limits. The 1% 50 mg/5 g row on that list also has a prior-authorization flag. On the California Ambetter from Health Net list, Testim is Tier 3 with PA. The policy requires a trial of generic testosterone gel, or a documented reason it cannot be used, before most non-injection products.

Does Health Net require prior authorization for testosterone?

For the brands listed in CP.CPA.291, yes. The California 4-tier list adds a PA flag on the 1% 50 mg/5 g gel row even though other generic gel rows on that list do not show one. Office-administered testosterone therapy also requires prior authorization under the medical benefit, effective October 1, 2026. Generic cypionate and enanthate still have to meet the policy's diagnosis and two-lab rules.

Does Health Net cover Xyosted, Jatenzo, or Kyzatrex?

They are named in CP.CPA.291 as products that need prior authorization and, for those non-injection or brand-injection paths, a step through generic gel or generic injections. They do not appear by name on the California 4-tier list we opened. Your doctor can request an exception if the drug is not listed and is not specifically excluded. If that exception is approved, the list says the Tier 3 or Tier 4 copayment applies.

Will Male Excel or Hone bill Health Net?

No. Male Excel says it does not accept insurance, and Hone says it does not accept insurance or complete prior authorizations. You may be able to use HSA or FSA funds, depending on your plan administrator.

Is Ambetter from Health Net the same as other Ambetter plans?

No. Ambetter from Health Net in California has its own 2026 and 2027 drug lists, which differ in places from Health Net's California group 4-tier list and from the other-state Ambetter lists reviewed on Does Ambetter cover TRT?.

Sources

1. Health Net / Centene. Clinical Policy: Testosterone, CP.CPA.291, Last Review Date 11.26 on the PDF opened November 10, 2026. PDF
2. Health Net of California. 4 Tier Formulary, California Large Group and Small Group, updated November 1, 2026. PDF
3. Health Net of California. 4 Tier Formulary, California Large Group and Small Group, updated January 1, 2027. PDF
4. Health Net of California. Ambetter from Health Net Drug List, California Individual & Family Plans, updated November 1, 2026. PDF
5. Health Net of California. Ambetter from Health Net Drug List, California Individual & Family Plans, updated January 1, 2027. PDF
6. Health Net Health Plan of Oregon. Essential Drug List, October 1, 2026. PDF
7. Health Net of California. Prior Authorization Requirements, California Commercial, effective October 1, 2026. Health Net provider library
8. U.S. Food and Drug Administration. FDA issues class-wide labeling changes for testosterone products. fda.gov
9. Male Excel. Pricing page and pricing FAQ, checked November 10, 2026. Male Excel
10. Hone Health help center. Hone Health Membership Overview: Compare Basic, Plus & Premium Plans (updated September 29, 2026) and Do You Accept Insurance? (updated September 4, 2026). Hone

Related reading

• TRT providers that take insurance
• Testosterone prior authorization: denials and appeals
• What testosterone level qualifies for TRT?
• Does Ambetter cover TRT?
• Does Molina cover TRT?
• Does Medicare cover TRT?
• Does Medicaid cover TRT?
• Testosterone cypionate cost
• Testosterone gel cost
• Male Excel cost
• Hone TRT cost

Still not sure which TRT care route fits you? Use our free Find My TRT Path tool.