Pharmacy
Mandatory Generic Reimbursement (MGR) for Brand Drugs
Guidelines for mandatory generic reimbursement (MGR), including generic substitution requirements and member cost differences for brand drugs.
Medicare Advantage Plan Formularies and PA/ST Criteria
Review HMSA Medicare Advantage formularies, including covered drugs, prior authorization, and PA/ST criteria for providers.
Medicare Part D Prescription Drug Coverage Exclusions
Guidelines for Medicare Part D prescription drug coverage exclusions, including non-covered drugs, limitations, and requirements for plan benefits.
Opioid Antitussive Quantity Limits and Opioid Quantity Limits
Understand opioid and opioid antitussive quantity limits, including coverage guidelines, restrictions, and safe medication use requirements.
Payment Policy - Chemotherapy Drugs and Services
Payment policy outlining reimbursement for chemotherapy drugs, administration, and related services, including all-inclusive rates, billing guidelines, and coverage criteria for providers.
Pharmacies That Participate with HMSA's Drug Plans
View the latest HMSA pharmacy directories for Commercial, Akamai Advantage®, and QUEST drug plans, plus archived pharmacy network listings.
Pharmacy and Formulary – Benefits and Copayments
Explore pharmacy and formulary information, including covered medications, drug lists, and guidelines to support safe, effective prescription use.
Pharmacy Non-Specialty Drug Policies
Explore pharmacy non-specialty drug policies, including coverage criteria, prior authorization requirements, and medication management guidelines.