Health Alliance Plan (HAP) policy updates
Track new and updated Health Alliance Plan (HAP) policies impacting reimbursement and clinical operations.
| Policy | Payer | Type | Specialty | Change | Effective |
|---|---|---|---|---|---|
| Alpha-1 Antitrypsin (AAT) deficiency therapies prior authorization | Health Alliance Plan (HAP) | Clinical | Pulmonology | Modified | Aug 1, 2026 |
| Step Therapy Criteria — Levalbuterol HFA and Metformin Oral Solution | Health Alliance Plan (HAP) | Clinical | Pharmacy & Specialty Drugs | Modified | Aug 1, 2026 |
| Prior Authorization Criteria — A1-PI Augmentation Products and Selected Specialty Agents | Health Alliance Plan (HAP) | Clinical | Pulmonology | Modified | Jul 1, 2026 |
| Albuterol step therapy (levalbuterol and metformin solution listed under Albuterol policy header) | Health Alliance Plan (HAP) | Clinical | Pharmacy & Specialty Drugs | Modified | Jul 1, 2026 |
| DME Services that require Prior Authorization List | Health Alliance Plan (HAP) | Administrative | — | Modified | Jun 1, 2026 |
| DME Services that require Prior Authorization List | Health Alliance Plan (HAP) | Administrative | — | Modified | Apr 1, 2026 |
| Qualified Health Plan Prescription Drug Formulary / Coverage Criteria | Health Alliance Plan (HAP) | Clinical | Pharmacy & Specialty Drugs | Modified | Jan 1, 2026 |
| HAP Medicare Part B Prior Authorization and Step Therapy Criteria | Health Alliance Plan (HAP) | Clinical | Pharmacy & Specialty Drugs | Modified | Jan 1, 2026 |
| Medicare Part B Prior Authorization and Step Therapy Criteria | Health Alliance Plan (HAP) | Clinical | Pharmacy & Specialty Drugs | Modified | Jan 1, 2026 |
| Commercial Prescription Drug Formulary — Coverage Criteria | Health Alliance Plan (HAP) | Clinical | Pharmacy & Specialty Drugs | Modified | Oct 1, 2025 |
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.