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HMSA's Select and Choice Drug Formulary and Coverage Codes, and Childrens Formulary

 

Select Formulary Coverage Codes

113

129

140

152

203

258

264

265

266

349

351

352

353

357

358

362

363

364

367

371

372

374

375

376

379

394

395

396

412

435

439

484

495

496

497

516

517

553

554

560

575

577

602

603

606

613

614

633

641

642

643

644

649

650

651

652

674

676

680

683

684

685

686

687

688

690

692

696

697

698

699

706

707

708

711

712

714

715

716

717

718

719

720

721

723

724

769

783

811

812

813

814

835

836

837

838

839

840

841

842

843

844

845

846

851

852

853

854

855

856

857

858

859

868

869

881

00A

00V

 

 

Choice Formulary Coverage Codes

164

171

175

229

243

244

273

274

304

305

321

339

344

380

381

498

500

578

579

667

668

669

671

828

829

849

850

 

 

 

Limited Rx Formulary Coverage Codes

465

466

467

468

485

486

488

489

574

760

761

762

763

764

765

766

770

771

772

773

774

775

776

790

867  

 

 

HMSA Formulary †, * 

 

To view the current drug formularies, please click the links below:

 

HMSA's Select, Choice and Childrens Drug Formulary - effective January 1, 2018

 

HMSA's Select, Choice and Childrens Drug Formulary  (Excel - 2003/XP version) - effective January 1, 2018

 

HMSA's Select Drug Formulary (abridged) - effective October 1, 2017

 

Brand drugs not listed in the formulary should be considered OTHER BRAND.

 

* The online HMSA Drug Formulary is updated quarterly. Providers may request a CD version of the formulary by contacting HMSA Provider Services.

 

 

 

 

 

To view previous versions of formularies that are now expired and archived, please click on the links below:

 

HMSA's Select, Choice and Childrens Drug Formulary - effective October 1, 2017

 

HMSA's Select, Choice and Childrens Drug Formulary  (Excel - 2003/XP version) - effective October 1, 2017

 

HMSA's Select, Choice and Childrens Drug Formulary - effective August 1, 2017

 

HMSA's Select, Choice and Childrens Drug Formulary  (Excel - 2003/XP version) - effective August 1, 2017

 

HMSA's Select Drug Formulary (abridged) - effective July 1, 2017

 

HMSA's Select, Choice and Childrens Drug Formulary - effective July 1, 2017

 

HMSA's Select, Choice and Childrens Drug Formulary  (Excel - 2003/XP version) - effective July 1, 2017

 

HMSA's Select, Choice and Childrens Drug Formulary - effective May 1, 2017

 

HMSA's Select, Choice and Childrens Drug Formulary  (Excel - 2003/XP version) - effective May 1, 2017

 

HMSA's Select Drug Formulary (abridged) - April 1, 2017

 

HMSA's Select, Choice and Childrens Drug Formulary - effective April 1, 2017

 

HMSA's Select, Choice and Childrens Drug Formulary (Excel - 2003/XP version) - effective April 1, 2017

 

HMSA's Select, Choice and Childrens Drug Formulary - effective March 1, 2017

 

HMSA's Select, Choice and Childrens Drug Formulary  (Excel - 2003/XP version) - effective March 1, 2017

 

HMSA's Select Drug Formulary (abridged) - January 1, 2017

 

HMSA's Select, Choice and Childrens Drug Formulary - February 1, 2017

 

HMSA's Select, Choice and Childrens Drug Formulary  (Excel - 2003/XP version) -  February 1, 2017

 

HMSA's Select, Choice and Childrens Drug Formulary - January 1, 2017

 

HMSA's Select, Choice and Childrens Drug Formulary  (Excel - 2003/XP version) -  January 1, 2017

 

HMSA's Select Drug Formulary (abridged) - effective December 1, 2016

 

HMSA's Select, Choice and Childrens Drug Formulary - December 1, 2016

 

HMSA's Select, Choice and Childrens Drug Formulary  (Excel - 2003/XP version) - December 1, 2016

 

HMSA's Select, Choice and Childrens Drug Formulary - effective October 1, 2016; updated November 1, 2016

 

HMSA's Select, Choice and Childrens Drug Formulary  (Excel - 2003/XP version) - effective October 1, 2016; updated November 1, 2016

 

HMSA's Select Drug Formulary (abridged) - October 1, 2016

 

HMSA's Select, Choice and Childrens Drug Formulary - effective October 1, 2016

 

HMSA's Select, Choice and Childrens Drug Formulary  (Excel - 2003/XP version) - October 1, 2016

 

HMSA's Select, Choice and Childrens Drug Formulary - July 1, 2016; updated August 15, 2016

 

HMSA's Select, Choice and Childrens Drug Formulary  (Excel - 2003/XP version) - July 1, 2016; updated August 15, 2016

 

HMSA's Select, Choice and Childrens Drug Formulary - effective July 1, 2016; updated August 1, 2016

 

HMSA's Select, Choice and Childrens Drug Formulary  (Excel - 2003/XP version) - effective July 1, 2016; updated August 1, 2016

 

HMSA's Select Drug Formulary (abridged) - July 1, 2016

 

HMSA's Select, Choice and Childrens Drug Formulary - July 2016

 

HMSA's Select, Choice and Childrens Drug Formulary (Excel - 2003/XP version) - July 2016

 

HMSA's Select, Choice and Childrens Drug Formulary - April 2016

 

HMSA's Select, Choice and Childrens Drug Formulary (Excel - 2003/XP version) - April 2016

 

Select Drug Formulary (abridged) - April 2016

 

Select Drug Formulary - January 2016

 

Select Drug Formulary - October 2015

 

First Published:05/24/2016
Latest Revision:12/22/2017
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