Hawaii Medical Service Association (HMSA) Prior Authorization Lookup
- Hawaii Medical Service Association (HMSA) coverage criteria
- Hawaii Medical Service Association (HMSA) contact directory
- All Hawaii Medical Service Association (HMSA) policy updates
Latest Hawaii Medical Service Association (HMSA) prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2025-01-01Botulinum Toxins — Coverage Criteria (prior authorization to CVS Caremark Specialty Programs)Defines clinical and administrative requirements for prior authorization and medical necessity of botulinum toxin products (e.g., Botox, Dysport, Xeomin, Myobloc, Daxxify) for a range of neurologic and other indications under the payer's prescription/specialty benefit; applies to providers submitting authorization to CVS Caremark for HMSA members.All Hawaii Medical Service Association (HMSA) updates
- Prior AuthClinical/Medical PolicyEff. 2024-05-01Global Medicare Advantage Medical Prior Authorization Request (Specialty Drugs Coverage Criteria)Form and criteria used by CVS Caremark on behalf of HMSA to collect information and authorize coverage for certain specialty medications for Medicare Advantage members; affects prescribers seeking drug coverage under the medical or pharmacy benefit.All Hawaii Medical Service Association (HMSA) updates
- Prior AuthClinical/Medical PolicyEff. 2019-01-01Coverage for Our Care, Our Choice Act (OCOCA) medications and visitsGovernance of Medicaid coverage, billing, and prior authorization processes for medical aid-in-dying medications and required visits under Hawaii's Our Care Our Choice Act (applies to QUEST Integration plans and Fee-For-Service Medicaid providers).All Hawaii Medical Service Association (HMSA) updates
- Prior AuthClinical/Medical PolicyActemra (tocilizumab), Tofidence, Tyenne prior authorizationPrior authorization form and clinical criteria used by CVS Caremark on behalf of HMSA Medicare Advantage to determine coverage for Actemra, Tofidence, and Tyenne for specified indications. Applies to prescribers requesting coverage for these medications under the patient's prescription/specialty benefit.All Hawaii Medical Service Association (HMSA) updates
- Prior AuthClinical/Medical PolicyBotulinum Toxin Prior Authorization and Coverage Criteria (HMSA Medicare Advantage)Prior authorization form and clinical criteria governing CVS Caremark's approval of botulinum toxin products for HMSA Medicare Advantage, including required documentation, ICD-10 coding rules, preferred-product step therapy, and exclusions.All Hawaii Medical Service Association (HMSA) updates
- Prior AuthClinical/Medical PolicyBotulinum Toxins (Botox, Dysport, Xeomin, Myobloc, Daxxify) — Prior AuthorizationPrior authorization form and clinical criteria for coverage of botulinum toxin products under HMSA/CVS Caremark prescription benefits; applies to prescribers requesting drug coverage for HMSA members.All Hawaii Medical Service Association (HMSA) updates
- Prior AuthClinical/Medical PolicyBotulinum Toxins (Botox, Dysport, Xeomin, Myobloc, Daxxify) — Prior Authorization CriteriaPrior authorization form and criteria for coverage of botulinum toxin products administered through CVS Caremark for HMSA members; applies to providers requesting coverage for these medications.All Hawaii Medical Service Association (HMSA) updates
- Prior AuthClinical/Medical PolicyBotulinum toxin prior authorization (Botox, Dysport, Xeomin, Myobloc, Daxxify)Prior authorization form and clinical criteria used by CVS Caremark/HMSA for coverage determination of botulinum toxin products for various indications; applies to prescribers submitting requests for member drug benefit coverage.All Hawaii Medical Service Association (HMSA) updates
- Prior AuthClinical/Medical PolicyBotulinum toxin prior authorization and coverage criteriaDefines CVS Caremark/HMSA prior authorization questionnaire and medical necessity criteria for coverage of botulinum toxin products (Botox, Dysport, Xeomin, Myobloc, Daxxify) across neurologic and related indications for HMSA members.All Hawaii Medical Service Association (HMSA) updates
- Prior AuthClinical/Medical PolicyCVS Caremark Prior Authorization Request — Biologic Therapy for SLE and Lupus NephritisThis is a CVS Caremark prior authorization form used by HMSA to collect clinical and demographic information to determine coverage for certain medications (notably biologics) for patients with systemic lupus erythematosus (SLE) or active lupus nephritis; it affects prescribers and pharmacy/specialty benefit administrators processing prior authorizations.All Hawaii Medical Service Association (HMSA) updates
- Prior AuthClinical/Medical PolicyCVS Caremark prior authorization form for denosumab (Prolia) and listed biosimilars — coverage criteriaThis document is a CVS Caremark prior authorization form used by HMSA to collect clinical and administrative information required to authorize coverage for specific specialty osteoporosis medications (Prolia and listed biosimilars) for HMSA members. It affects prescribing clinicians and staff submitting authorization requests.All Hawaii Medical Service Association (HMSA) updates
- Prior AuthClinical/Medical PolicyCommercial Fax FormA prior authorization questionnaire/form used by CVS Caremark for HMSA members to determine coverage eligibility for certain biologic or targeted synthetic medications across indications including CAPS, DIRA, and recurrent pericarditis; gathers clinical, demographic, TB screening, prior therapy and prescriber specialty information and requires documentation attachments for approvals.All Hawaii Medical Service Association (HMSA) updates
- Prior AuthClinical/Medical PolicyCommercial Fax FormA physician fax prior authorization form (CVS Caremark/HMSA) to support coverage determinations for an amyloid beta-directed antibody (Leqembi) for patients with Alzheimer's disease; collects clinical criteria, baseline testing, safety monitoring (ARIA), and continuation/reauthorization data required for approval.All Hawaii Medical Service Association (HMSA) updates
- Prior AuthClinical/Medical PolicyDenosumab (Xgeva and biosimilars) prior authorizationPrior authorization form and criteria for coverage of denosumab products (Xgeva and listed biosimilars) for HMSA Medicare Advantage members; used by prescribers to request approval via CVS Caremark Specialty. Affects prescribers, pharmacies, and CVS Caremark reviewers.All Hawaii Medical Service Association (HMSA) updates
- Prior AuthClinical/Medical PolicyDrugs Requiring Prior Authorization — Pharmacy & Specialty Drugs Coverage CriteriaLists prescription drugs that require prior authorization from HMSA Akamai Advantage (PPO) and summarizes coverage criteria, required documentation, prior‑therapy and age/prescriber limits, and duration rules.All Hawaii Medical Service Association (HMSA) updates
- Prior AuthClinical/Medical PolicyDrugs Requiring Prior Authorization — Pharmacy & Specialty Drugs Coverage CriteriaLists drugs that require prior authorization from HMSA Akamai Advantage (PPO) and the criteria/documentation required for coverage; applies to members and prescribers seeking coverage for medications shown in the chart.All Hawaii Medical Service Association (HMSA) updates
- Prior AuthClinical/Medical PolicyDrugs That Require Prior Authorization (PA)Lists prescription drugs that require prior authorization from HMSA Akamai Advantage (PPO) and summarizes indication-specific PA criteria, exclusions, required documentation, and coverage durations for prescribers, patients, and appointed representatives.All Hawaii Medical Service Association (HMSA) updates
- Prior AuthClinical/Medical PolicyDrugs That Require Prior Authorization (PA) Before Being Approved for CoverageList of prescription drugs that require prior authorization under HMSA Akamai Advantage (PPO) with indication-specific clinical criteria, documentation requirements, and administrative instructions for requesting PA.All Hawaii Medical Service Association (HMSA) updates
- Prior AuthClinical/Medical PolicyDrugs That Require Prior Authorization (PA) — HMSA Akamai Advantage (PPO)Lists drugs that require prior authorization under the HMSA Akamai Advantage (PPO) plan and summarizes PA criteria, required documentation, restrictions, and coverage durations for listed specialty and pharmacy drugs.All Hawaii Medical Service Association (HMSA) updates
- Prior AuthClinical/Medical PolicyDrugs That Require Prior Authorization — HMSA Akamai Advantage (PPO)Lists prescription drugs that require prior authorization from HMSA Akamai Advantage (PPO) and summarizes coverage criteria, required documentation, restrictions, and durations for each listed drug.All Hawaii Medical Service Association (HMSA) updates
- Prior AuthClinical/Medical PolicyDrugs That Require Prior Authorization — Pharmacy & Specialty DrugsLists specialty drugs requiring prior authorization from HMSA Akamai Advantage (PPO) and summarizes required documentation, indication-specific criteria, exclusions, step therapy, quantity limits, and coverage durations.All Hawaii Medical Service Association (HMSA) updates
- Prior AuthClinical/Medical PolicyDrugs That Require Prior Authorization — Pharmacy & Specialty DrugsList of prescription drugs that require prior authorization from HMSA Akamai Advantage (PPO) and the clinical/administrative criteria used to approve coverage for those drugs; applies to members and prescribers seeking coverage for medications shown in this portion of the policy.All Hawaii Medical Service Association (HMSA) updates
- Prior AuthClinical/Medical PolicyDrugs That Require Step Therapy (ST) Before Being Approved for CoverageDefines drugs that require step therapy (ST) before HMSA Akamai Advantage (PPO) will approve coverage and instructs how to request prior authorization; applies to members and prescribers under the HMSA Akamai Advantage plan.All Hawaii Medical Service Association (HMSA) updates
- Prior AuthClinical/Medical PolicyDrugs That Require Step Therapy Prior to CoverageThis policy lists specific drugs that require prior authorization and step therapy (trial of preferred generic or alternative agents) before HMSA Akamai Advantage (PPO) will provide coverage. It affects members enrolled in that plan and their prescribers seeking coverage for listed drugs.All Hawaii Medical Service Association (HMSA) updates
- Prior AuthClinical/Medical PolicyGattex (teduglutide) — Prior Authorization Criteria for Short Bowel SyndromePrior authorization form and clinical criteria used by HMSA/CVS Caremark to determine coverage for Gattex (teduglutide) for patients with short bowel syndrome (SBS), including adult and pediatric initial and continuation criteria and site-of-care information. Affects prescribers and pharmacy specialty program staff administering or dispensing Gattex.All Hawaii Medical Service Association (HMSA) updates
1–25 of 115
1 / 5
Tool Description
Search Hawaii Medical Service Association (HMSA)prior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Prior Authorization by Payer
Go deeper
Explore OpenPayer Data
Prior auth requirements change all the time. Keep up with every payer policy update in the live policy feed, or browse payers with prior authorization policies.
Toolbox
More OpenPayer Tools
- Billing Code LookupSearch CPT, HCPCS, J-codes, DRG, and dental codes by number or procedure name.
- Healthcare Provider & Facility LookupFind hospitals and healthcare facilities by name, taxonomy, facility type, ownership, or state.
- Health Insurance Payer LookupSearch national health insurance payers and health plans by name and state presence.
- Provider Taxonomy Code LookupSearch NUCC taxonomy codes by code, specialty, grouping, or classification.
- CPT Modifier LookupSearch CPT modifiers by code or name — descriptions, when to use them, and payer policy context.
- Timely Filing LookupFind payer timely filing policies: claim deadlines, corrected claim windows, and appeal timeframes.
- Coverage Criteria LookupSearch payer coverage criteria and medical necessity requirements by drug, procedure, or payer.
- Payer Contact DirectoryClaims, prior authorization, provider services, and appeals contacts for health insurance payers.
Published by
Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.