All PlansCoverageMedium impact
Medical Specialty Drug Policies O R
HMSA·Pharmacy
We identified it
Jun 20, 2026
Summary
HMSA has updated their medical specialty drug policies for drugs beginning with letters O through R. This appears to be a pharmacy benefit policy update that may affect prior authorization requirements, coverage criteria, or billing procedures for specialty medications in this alphabetical range.
Action Required
Immediately: Billing team should review the updated HMSA Medical Specialty Drug Policies O-R at https://prc.hmsa.com/s/article/Medical-Specialty-Drug-Policies-O-R to identify any changes to prior authorization requirements, coverage criteria, or billing procedures for specialty drugs. Update billing system rules and prior authorization workflows as needed based on policy changes identified.