Drug Tools: Akamai Advantage Preferred 2014

Use these tools and services to get the most out of your prescription drug coverage through HMSA.


Formulary

The formulary is the plan’s list of covered drugs. Use these tools to find out if your drugs are covered and if there are limits associated with them.

Formulary search

Use our search tool to find your medications, or download the latest version of our Comprehensive Formulary. Our Comprehensive Formulary is the latest version of the full list of the plan’s covered drugs, including the tier of each drug and any additional requirements/limits or limited availability.

Formulary search

Comprehensive formulary

Prior authorization

Certain drugs require prior authorization from HMSA before we can cover them even if you have a prescription.

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Quantity limits

For certain drugs, Akamai Advantage limits the amount of the drug that we’ll cover.

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Step therapy

In some cases, we may ask you to try certain drugs first to treat your condition before we'll cover another drug for the same condition.

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Pharmacy Network

Use our network of participating pharmacies to access your prescription drug benefit.

Find a pharmacy

Use our large pharmacy network to get prescription drugs in Hawaii or while you’re traveling on the U.S. Mainland.

Provider Directory

The Provider Directory includes a list of our network pharmacies and other participating providers.


Tools to help you get the most out of your plan

Drug Comparison Tool

Find out if your medications are covered in our formulary, find available generic alternatives, and monitor your benefit status when you’re in the coverage gap.

Extra Help

Do you need help paying for your drugs? The Low-Income Subsidy Program can help you reduce your copayments and fill in the coverage gap.

Medication Therapy Management Program

Some members may qualify for this program, which offers a private consultation with a pharmacist to review your medication use.

Mail–Order Service

Use the plan’s mail–order service to get an extended day supply of a maintenance medication for a chronic condition. You could save money and time with Mail Order. Sign up by calling FastStart at 1-800-875-0867 or visiting HMSA’s My Account.


Evidence of Coverage

Use this booklet to learn about the details and rules of your plan. It also gives you important information like phone numbers, benefit charts to help you understand what's covered, and your rights and responsibilities as an HMSA Akamai Advantage member.

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Coverage determination

EOC Chapter 9 Sec. 6.4

You can ask us to make a coverage determination about the drugs or payment you need like prescribed drug coverage, quantity limits, prior authorization, step therapy, and tiered cost sharing.

Appeals

EOC Chapter 9 Sec. 6.5

If your request for prescription drugs or drug coverage has been denied, you can appeal that decision.

Exceptions

EOC Chapter 9 Sec. 6.2

If a drug isn’t covered the way you’d like, we’ll try and work with you. Exceptions are sometimes made to get you what you need.

Transition proccess

EOC Chapter 5 Sec. 5.2

If your drug isn’t covered on the drug list, HMSA may offer a temporary supply of that drug. It gives you and your provider a chance to find an alternative treatment.


Coverage determinations and appeals

Coverage determinations

If you need a drug that isn't on our formulary, or you need an exception to prior authorizations, quantity limits, step therapy or drug tiering, you or your prescriber can ask us to make a coverage determination (also called a coverage decision) or an exception to our formulary.

Instructions Download

Appeals

If your request for prescription drugs or drug coverage has been denied, you can appeal that decision.

Instructions Download

Appointing a representative

You can name another person to act as your representative for certain health care decisions.

Instructions Download