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Xyrem
Hawaii Medical Service Association (HMSA)
Hawaii Medical Service Association (HMSA) Coverage for Xyrem
All
8
Commercial
3
Health Exchange
2
Managed Medicaid
1
Medicare
2
Commercial
Commercial - HMO
PA Required
Step Therapy
No Quantity Limit
See Details
Commercial - PPO
PA Required
Step Therapy
No Quantity Limit
See Details
Commercial - Other Insurer
PA Required
Step Therapy
Quantity Limit
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Health Exchange
Health Exchange - PPO - Health Insurance Exchange
PA Required
Step Therapy
Quantity Limit
See Details
Health Exchange - HDHP - Health Insurance Exchange
PA Required
Step Therapy
Quantity Limit
See Details
Managed Medicaid
Managed Medicaid - HMO - Medicaid
PA Required
No Step Therapy
No Quantity Limit
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Medicare
Medicare - Medicare Advantage Part D
No PA
No Step Therapy
No Quantity Limit
See Details
Medicare - Prescription Drug Plan
No PA
No Step Therapy
No Quantity Limit
See Details
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