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HealthPro News – November 2026 [PDF]
Medicare Part D Newsletter [PDF]
HealthPro News
A monthly publication for participating HMSA health care providers, facilities, and their staff.
November 2026
| ADMINISTRATION & NEWS | |
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Advanced Primary Care Management Update [PDF] Effective Jan. 1, HMSA will apply the existing APCM non-coverage policy to UB-04 claims. |
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Improving Appropriate Antibiotic Use [PDF] Most cases of acute bronchitis are viral and don’t benefit from antibiotics. |
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Submit your attestation each quarter. |
| CONTRACT NOTIFICATION | |
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Effective as of Oct. 1. |
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Significant Changes for Policies Requiring 60-day Notice [PDF] Effective Jan. 1. |
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Annual Review of Medical Specialty Drug Policies [PDF] Effective Jan. 1. |
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Effective Dec. 1. |
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These policies will no longer be used when reviewing requests for coverage. |
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Essential Drug Formulary Changes [PDF] Effective Jan. 1. |
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Federal Plan 87 Drug Formulary Changes [PDF] Effective Jan. 1. |
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Metallic Drug Formulary Changes [PDF] Effective Jan. 1. |
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Optimal Drug Formulary Changes [PDF] Effective Jan. 1. |
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Postal Service Drug Formulary Changes [PDF] Effective Jan. 1. |
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Select Drug Formulary Changes [PDF] Effective Jan. 1. |
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Effective Jan. 1. |
| CODING & CLAIMS | |
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The Payment Policy Manual for changes. |
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Maternity Coding Changes [PDF] The changes move maternity services from a global billing model to an unbundled, encounter-based approach. |
| PHARMACY | |
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New Requirements for Anti-Obesity Medications [PDF] An update to prior authorization requirements for anti-obesity medication. |
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Sex-Trait Hormone Therapy Benefit Change [PDF] Federal plans will no longer cover hormone therapies prescribed solely for sex-trait modification. |
| PLANS | |
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HMSA Akamai Advantage Select Plus (HMO) [PDF] A new Medicare Advantage option for eligible members on Oahu in 2027. |
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HMSA’s Online Care Access [PDF] HOC will no longer be a benefit for HMSA Medicare Advantage members. |
| PROGRAMS | |
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New Quality Program Launches [PDF] The program is designed to support high-quality care through a transparent and data-driven methodology. |
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Change in ASAM Criteria Delayed [PDF] The new implementation date is July 1, 2027, instead of Jan. 1, 2027. |
| POLICY NEWS | |
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Annual Review of Medical Policies [PDF] Effective as of Sept. 25. |
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Effective Jan. 1. |
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Placement of Treatment – Office Procedure List [PDF] Effective Jan. 1. |
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Placement of Treatment – Outpatient Procedure List [PDF] Effective Jan. 1. |
| CALENDAR | |
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Health Education Workshops [PDF] No-cost sessions that can help your patients. |
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Health- and fitness-related activities. Nominal fees. |
· COMMERCIAL · QUEST · MEDICARE
Medicare Part D
Click the links below to learn more.
November 2026
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General Information about HMSA Medicare Advantage Part D [PDF] |
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View past issues of HMSA’s HealthPro News in the Provider Resource Center.
