Formularies

Hawaii Healthcare Information Network (HHIN+) Login

† 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.

**Boldface type indicates generic availability. However, not all strengths or dosage forms of the generic name in boldface type may be generically available. If the generic is boldfaced, the generic is covered and the brand name product will be non-formulary. The exception is for State mandated drug classes (Anti-Retroviral Agents, Hepatitis C Agents, Anti-Depressants, Anti-Psychotics, Anti-Anxiety Agents, and Immunosuppressants), where both the generic is covered as well as the brand name product equivalent with a dispense as written code 1 (DAW).

HMSA Pharmacy & Therapeutics (P&T) Advisory Committee

The HMSA Pharmacy & Therapeutics (P&T) Advisory Committee serves to advise HMSA regarding its health plan coverage to ensure HMSA members have access to high-quality, cost-effective medications. The P&T Advisory Committee meets on a quarterly basis and provides HMSA with recommendations regarding:

• Drug management programs which serve to enhance the appropriate use of drugs. Such management programs include, but are not limited to, drug utilization review (DUR), member safety initiatives, therapeutic or clinical protocols, therapeutic interchange, diagnoses requirements, age or gender edits, quantity limits, and stepped therapy.

The P&T Advisory Committee is comprised of practicing physicians and pharmacists from the community, who serve voluntarily and are not compensated for their participation. HMSA Medical Directors, representing each of HMSA’s major lines of business, and staff pharmacists serve as non-voting members of this committee.

Drug Evaluation Process

Review Criteria

For a drug to be reviewed for proposed change due to the HMSA formulary, it must be approved by the Federal Food and Drug Administration (FDA) for an indication(s) that would benefit patients in an outpatient setting with a covered medical condition. The drug must also offer a distinct clinical advantage(s) over existing medications of comparable therapeutic effects listed on the formulary.

Review Requests

Providers requesting changes of a drug status on the formulary are asked to explain the reason for their request, to suggest appropriate restrictions or guidelines for use, and to provide references from medical literature to be included in the review.

• The Application for Formulary Review [PDF] should be completed with supporting documents and mailed or faxed to:

HMSA-Pharmacy Management

818 Keeaumoku St.

Honolulu, HI  96814

Fax: 808-948-8282

Please email questions or comments regarding HMSA Drug Formulary revisions to HMSAPharmacists@HMSA.com. Incomplete applications will be returned to the requestor.

Revision History