Drug Categories

Your HMSA drug plan manages costs for you and all of our members through the use of drug categories, with generic drugs being the least expensive. The following list explains the type of drugs that fall into each category.

Consult your health care provider to find the right prescription drug for you.

  • Generic drugs - lowest copayment: Generic drugs are sold under their common generic or chemical name. Generics have the same active ingredients as their brand-name equivalents and have been found to be safe and effective by the U.S. Food and Drug Administration. HMSA encourages the use of generics because their low cost results in the lowest copayment for you.
  • Preferred brand name and single-source generic drugs - higher fixed copayment: Some brand-name drugs are designated as preferred brand drugs when generic alternatives aren’t available or do not adequately represent a therapeutic class. For preferred brand and single-source generic drugs, you pay a higher fixed copayment than for generics. Some HMSA plans have a provision for single-source generics at this copayment level. Please read your plan certificate for more information.
  • Other brand drugs - higher fixed copayment plus cost share: Other brand drugs have a higher member copayment. For most members, the out-of-pocket cost for other brand drugs is the preferred brand drug copayment plus the cost share.
  • Specialty drugs - highest copayment, copayment is either fixed or a percentage of the eligible charge: This is a benefit for some but not all of HMSA’s drug plans. Please read your plan certificate for more information. These are high-cost oral or inhaled drugs that are used to treat chronic, potentially life-threatening diseases. They’re often part of complex treatment regimens that require special handling, high level of patient education, close supervision, and monitoring on an ongoing basis. Specialty drugs are covered only when purchased from select providers and aren’t available through HMSA’s Mail-Order Prescription Drug Program. To find a participating specialty pharmacy in Hawaii:
    • Go to Find a Doctor on hmsa.com.
    • Type pharmacy in the search box.
    • Click Select your plans. Select Drug HMO or Drug PPO and save your changes. Click the magnifying glass in the blue box to begin your search.
    • Narrow your search by clicking on Specialty Pharmacy in the left column of the screen.

Note: Refer to your plan certificate for information on the specific benefits and provisions of your plan.