Medical Policies – Medical Pharmacy

HMSA has medical policies, many of which apply to injectable drugs and DME items. The policies are listed in Medical Policies.

Pharmacies participating with HMSA’s medical plans should reference the medical policies for drugs or DME items they provide to ensure that all applicable requirements have been met.

Examples:

• If a drug requires precertification, the pharmacy should communicate with the physician’s office to verify that precertification has been given.
• If a drug has quantity limits, the pharmacy should be sure to dispense only the amount allowed under the policy.
• If a DME item requires a CMN or DIF it is important that these documents be attached to the claim. See Durable Medical Equipment Items Requiring CMN or DIF.

Revision History