HMSA Drug Plans

HMSA Private Business Plans

HMSA Non-Formulary Plans

HMSA Non-Formulary plans offers two tiers of drug benefits.

• The first tier contains generic drugs.
• The second tier is comprised of brand drugs.

Note: There may be drugs which are specifically excluded from coverage, such as over-the-counter medication, vitamins, drugs for cosmetic uses, and drugs for sexual dysfunction or infertility.

HMSA Choice Formulary Plans

The HMSA Choice Formulary is a four-tiered open formulary. An open formulary includes all prescription drugs except those that are excluded under the health plan benefit. Brand drugs which are not listed on the formulary are considered Tier 3 Other Brand drugs and generics not listed are on Tier 1.

• The first tier contains mostly generic drugs.
• The second tier contains Preferred brand drugs.
• The third tier contains Other Brand drugs.
• The fourth tier contains Specialty drugs which are typically high in cost and require specialized care. Specialty drugs are limited to a 30 day supply and must be filled at a participating specialty pharmacy.

Note: There may be drugs which are specifically excluded from coverage, such as over-the-counter medication, vitamins, drugs for cosmetic uses, and drugs for sexual dysfunction or infertility.

HMSA Select Formulary Plans

The HMSA Select Formulary is a four-tiered open formulary. An open formulary includes all prescription drugs except those prescription drugs that are excluded under the health plan benefit. Brand drugs which are not listed on the formulary are considered Tier 3 Other Brand drugs and generics not listed are on Tier 1.

• The first tier contains generic prescription drugs.
• The second tier contains Preferred brand prescription drugs with advantages (efficacy, safety, and/or overall value) over other brand options.
• The third tier contains Other Brand name prescription drugs without advantages (efficacy, safety, and/or overall value) over other options or new brand drugs to market.
• The fourth tier contains Specialty drugs which are typically high in cost and require specialized care. Specialty drugs are limited to a 30 day supply and must be filled at a participating specialty pharmacy.

Note: There may be drugs which are specifically excluded from coverage, such as over-the-counter medication, vitamins, drugs for cosmetic uses, and drugs for sexual dysfunction or infertility.

HMSA Essential Prescription Formulary Plans

The HMSA Essential Prescription Formulary is a five-tiered managed formulary which limits the number of prescription medications covered and requires prior authorization for drugs that are non-formulary.

• The first tier contains mostly generic prescription drugs.
• The second tier contains some generic prescription drugs AND Preferred brand prescription drugs with advantages (efficacy, safety, and/or overall value) over other options.
• The third tier contains non-preferred brand name prescription drugs without advantages (efficacy, safety, and/or overall value) over other options, but with lower overall net costs compared to non-formulary drugs.
• The fourth tier contains preferred Specialty drugs with advantages (efficacy, safety, and/or overall value) over other Specialty drug options. Specialty drugs are typically high in cost and require specialized care. Specialty drugs are limited to a 30 day supply and must be filled at a participating specialty pharmacy.
• The fifth tier contains non-preferred specialty drugs without advantages (efficacy, safety, and/or overall value) over other Specialty Drug options. Specialty drugs are typically high in cost and require specialized care. Specialty drugs are limited to a 30 day supply and must be filled at a participating specialty pharmacy.
• Non-formulary drugs do not have advantages over other options or are new brand drugs to market.

Note: There may be drugs which are specifically excluded from coverage, such as over-the-counter medications, vitamins, drugs for cosmetic uses, and drugs for sexual dysfunction or infertility.

HMSA Children's Plan

The HMSA Children's Plan is an individual plan for children who are Hawaii residents and are 31 days through 18 years of age and are not enrolled in another health plan, including The HMSA Plan for QUEST Integration Members.

The HMSA Children's Plan offers limited drug benefits, which are listed in the Children's Plan Formulary. The formulary is closed, meaning only drugs listed are covered benefits of the plan.

QUEST Integration Plan

The HMSA QUEST Integration Formulary is managed, drives generic use, and uses over-the-counter products when possible. However, the formulary is fortified with selected brand drugs, which have been determined to be medically necessary when equivalent generic drugs are not available or the brand drug offers better therapeutic outcomes or a more favorable safety profile.

Medicare Advantage Plans

The HMSA Akamai Advantage® Formulary is a five-tiered closed formulary which limits the number of prescription medications covered and requires prior authorization for drugs that are non-formulary.

• Tier 1 - Preferred Generics
• Tier 2 - Non-Preferred Generics
• Tier 3 - Preferred Brands
• Tier 4 - Non-Preferred Brands
• Tier 5 - Specialty Tier

Revision History