Pharmacy
2026 Drug Plan Changes
Learn about 2026 drug plan changes, including updated medication coverage, formulary changes, cost-sharing updates, and member guidance.
Alcohol and Drug/Chemical Dependency Treatment
Learn about HMSA coverage for alcohol and drug dependency treatment, including inpatient and outpatient benefits, provider requirements, and authorization details.
Ambulatory Infusion
Learn about ambulatory infusion services, including how patients receive specialty IV therapies in a safe, monitored outpatient setting by skilled care teams.
Anti-Obesity Medication Policies for HMSA Federal Plan 87 Formulary and HMSA’s Postal Service Formulary ONLY
Learn about anti-obesity medications, including treatment options, eligibility criteria, benefits, risks, and support for long-term weight management.
Coordination of Benefits – Medicare Part D Plans
Guidelines for coordination of benefits with Medicare Part D plans, including coverage rules, primary payer determination, and pharmacy claims processing.
Drug Cost Tool – Member and Provider Information on real time benefits
Compare HMSA’s Drug Cost Tool with real-time benefits for members and providers. Check drug pricing, coverage details, and lower-cost options instantly.
Drug Review Request
Guidelines for submitting a drug review request, including when precertification is required and how to complete and submit the request form.
Drug Review Request Form and Instructions
Access the HMSA drug review request form and instructions, including submission steps, required details, and guidelines for processing coverage requests.
Drug Utilization Review
Guidelines for drug utilization review, including prospective and retrospective review processes, patient safety checks, and improving medication outcomes.
Entering Compound Drugs
Learn how to enter compound drugs in HMSA claims, including coding guidelines, billing procedures, and documentation requirements for accurate processing.