Aloha Care policy updates
Track new and updated Aloha Care policies impacting reimbursement and clinical operations.
| Policy | Payer | Type | Specialty | Change | Effective |
|---|---|---|---|---|---|
| 2026 AlohaCare Advantage Plus (HMO D-SNP) Drugs with Step Therapy Requirements | Aloha Care | Clinical | Pharmacy & Specialty Drugs | Modified | Aug 1, 2026 |
| 2026 AlohaCare Advantage (HMO D-SNP) Drugs with Step Therapy Requirements | Aloha Care | Clinical | Pharmacy & Specialty Drugs | Modified | Jun 1, 2026 |
| 2026 AlohaCare Advantage Plus (HMO D-SNP) Drugs with Step Therapy Requirements | Aloha Care | Clinical | Pharmacy & Specialty Drugs | Modified | Jun 1, 2026 |
| Beers Criteria prior authorization for older adults | Aloha Care | Clinical | Pharmacy & Specialty Drugs | Modified | May 13, 2026 |
| Applied Behavior Analysis (ABA) Services | Aloha Care | Clinical | Psychiatry/Behavioral Health | Modified | Mar 22, 2026 |
| Antiemetics for Oncology (NK1 RA, 5HT3 RA, combination) | Aloha Care | Clinical | Hematology/Oncology | Modified | Jan 1, 2026 |
| Dose Rounding for Systemic Therapy | Aloha Care | Clinical | Hematology/Oncology | Modified | Jan 1, 2026 |
| Preferred Products Guidelines — Injectable Oncology Medications | Aloha Care | Clinical | Hematology/Oncology | Modified | Jan 1, 2026 |
| Denosumab (Xgeva/Prolia and biosimilars) Medicare coverage criteria | Aloha Care | Reimbursement | Pharmacy & Specialty Drugs | Modified | Jan 1, 2026 |
| Biologic & Immunologic Agents — Coverage and Authorization Criteria | Aloha Care | Clinical | Immunology/Rheumatology | Modified | Dec 23, 2025 |
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OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.
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Coverage data is sourced from publicly available payer medical policy documents and updated as payers publish revisions. Read more about where our data comes from. Always consult the primary payer source for clinical decision-making.