Pharmacy Benefits

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Pharmacy Benefits

Pharmacy Benefits

The Hawaii Medical Service Association (HMSA) pharmacy benefit plan (860) supplements your HMSA comprehensive medical plan (797).

Here is how the plan works:

  • There is a separate out-of-pocket maximum for your pharmacy benefits.
  • Once you meet the pharmacy copayment maximum of$3,600 per person or $4,200 per family, you are no longer responsible for copayment amounts for prescription drugs and supplies.

For a detailed prescription drug list for your plan (860), please visit hmsa.com/drug-list.

HPN Solutions HMO

In-network

Prescription Drug Annual Out-of-Pocket Maximum

$3,600 individual / $4,200 family

Prescription Drugs (860) Retail (30-Day Supply)

Generic (Tier 1)

$7 copay

Preferred Brand Name (Tier 2)

$30 copay

Non-Preferred (Tier 3)

$30 copay plus $45 Tier 3 cost share

Speciality (Tier 4/ Tier 5)

$100 copay / $200 copay

Prescription Drugs (860) Mail Order (90-Day Supply)

Generic (Tier 1)

$11 copay

Preferred Brand Name (Tier 2)

$65 copay

Non-Preferred (Tier 3)

$65 copay plus $135 Tier 3 cost share

*The Mail Order (90-day supply) copays will also apply to 90-day supply retail prescriptions from a network pharmacy. After two grace fills, members will be required to fill 90-day maintenance prescriptions at CVS or use Optum mail-order.

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Website: hmsa.com

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