A coverage determination is HMSA’s initial decision about whether we’ll cover a prescription drug through your Essential, Optimal, and Metallic Prescription Formulary.
Your doctor can ask us to make a coverage determination about the drug(s) you need. If your health requires a quick response, your doctor can make an "expedited coverage determination." After we receive your doctor’s statement, we’ll give you an answer within:
- 72 hours for a standard coverage determination.
- 24 hours for an expedited coverage determination.
- Click Download at the top of the page.
- Print out the form and take it to your doctor to complete.
- Ask your doctor to submit the completed form by phone, fax, or mail.
P.O. Box 30980
Honolulu HI 96820-9930
Attn: PA department
If you have questions about the request process or the status of a request, contact CVS/caremark, HMSA’s pharmacy benefits manager. Call 1-855-240-0543 toll-free, 24 hours a day, seven days a week. TTY users, please call 1-800-863-5488 toll-free.CVS/caremark provides pharmacy benefit management services and manages HMSA’s drug formulary for HMSA’s commercial, Medicare, and QUEST Integration plans. CVS/caremark is an independent company.