All PlansPrior AuthMedium impact
Pharmacy Specialty Drug Policies A G
HMSA·HI·Pharmacy
We identified it
Jun 20, 2026
Summary
HMSA has updated their pharmacy specialty drug policies for drugs A-G. This affects billing and coverage for specialty medications that require special handling, prior authorization, or step therapy requirements.
Action Required
Immediately: Billing team should review the updated HMSA pharmacy specialty drug policies at the provider resource center to identify changes in prior authorization requirements, coverage criteria, and step therapy protocols for specialty drugs A-G. Update prior authorization checklists and notify providers of any new documentation requirements for specialty drug prescriptions.