Hawaii Medical Service Association (HMSA) policy updates
Track new and updated Hawaii Medical Service Association (HMSA) policies impacting reimbursement and clinical operations.
| Policy | Payer | Type | Specialty | Change | Effective |
|---|---|---|---|---|---|
| Botulinum Toxins — Coverage Criteria (prior authorization to CVS Caremark Specialty Programs) | Hawaii Medical Service Association (HMSA) | Clinical | Neurology/Neurosurgery | Modified | Jan 1, 2025 |
| 2025 List of Covered Drugs (Dual Care Supplemental Medicaid) | Hawaii Medical Service Association (HMSA) | Clinical | Pharmacy & Specialty Drugs | Modified | Jan 1, 2025 |
| EngageFitness Program Benefit Rider (Complementary Care Rider) | Hawaii Medical Service Association (HMSA) | Reimbursement | Other | Modified | Jan 1, 2025 |
| Global Medicare Advantage Medical Prior Authorization Request (Specialty Drugs Coverage Criteria) | Hawaii Medical Service Association (HMSA) | Clinical | Pharmacy & Specialty Drugs | Modified | May 1, 2024 |
| Coverage for Our Care, Our Choice Act (OCOCA) medications and visits | Hawaii Medical Service Association (HMSA) | Clinical | Home Health & Hospice | Modified | Jan 1, 2019 |
| Definitions (Subtitle 12, Title 17 — Med-QUEST Division) | Hawaii Medical Service Association (HMSA) | Administrative | — | Modified | Aug 1, 1994 |
| Prior authorization for denosumab products (Xgeva and biosimilars) | Hawaii Medical Service Association (HMSA) | Administrative | — | Modified | — |
| Prior Authorization Request Form — H.P. Acthar Gel / Purified Cortrophin Gel | Hawaii Medical Service Association (HMSA) | Administrative | — | Modified | — |
| Prior authorization request form for long-acting CSF biologics | Hawaii Medical Service Association (HMSA) | Administrative | — | Modified | — |
| Myalept prior authorization form / submission template | Hawaii Medical Service Association (HMSA) | Administrative | — | Modified | — |
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.
OpenPayer by Trek Health — Policy intelligence for billing and revenue cycle teams.
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.