Frequently Asked Questions: Pharmacy

How often is the HMSA Drug Formulary updated?

The HMSA Drug Formulary is updated quarterly, on Jan. 1, Apr. 1, July 1 and Oct. 1, based on recommendations by HMSA’s Pharmacy and Therapeutics Committee. The formulary may be accessed in an online (HTML) format or as a Microsoft Excel file. See Pharmacy and Formulary – Benefits and Copayments.

Where can I find information about HMSA’s Akamai Advantage® Prescription Drug Coverage formulary?

HMSA’s Akamai Advantage Prescription Drug Coverage is HMSA’s approved Medicare Part D plan. The plan has its own formulary, Formularies for Medicare Advantage Plans. Information about the plan is also located at HMSA Akamai Advantage.

How are drugs added to or removed from the formulary?

The HMSA Pharmacy and Therapeutics (P&T) Advisory Committee meets quarterly to provide HMSA with recommendations regarding drug placement on the formulary. The committee also makes recommendations on drug management programs such as therapeutic or clinical protocols and therapeutic interchange. The P&T Committee is composed of practicing physicians and pharmacists in the community who serve voluntarily and are not compensated for their participation.

Providers may request that a drug be reviewed for proposed addition to the HMSA formulary if it has been approved by the Food and Drug Administration (FDA) for an indication that would benefit patients in an outpatient setting with a covered medical condition. The drug must also offer a distinct clinical advantage over existing medications of comparable therapeutic effects listed on the formulary. See Pharmacy and Formulary – Benefits and Copayments for information about how to submit a request.

If the Argus claims processing system is down, how can I determine how much to charge HMSA Akamai Advantage members for their prescriptions?

Drug copayments and other information pertaining to HMSA Akamai Advantage members are available at HMSA Akamai Advantage.

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