Important changes to the 2011 Humana drug list
Why is the drug list changing?
The Pharmacy & Therapeutics Committee reviews and updates the drug list on an annual basis to ensure that drugs are placed in the most appropriate and cost-effective level. Changes are implemented to help ensure safety and control cost, as well as minimize fraud, waste, and abuse.
What do these changes mean?
Prior Authorization. Before the plan pays for certain medications, the doctor must get advance approval from Humana. This is called "prior authorization." Without prior authorization, the pharmacy cannot fill the prescription. Doctors can get prior authorization by faxing a request form to Humana's Clinical Pharmacy Review department.
Quantity Limits. Quantity limits are the maximum amount of a medicine Humana will cover for the copayment. Starting on January 1, 2011, if members fill or refill a prescription for any medicine with quantity limits, they can get up to the quantity limit. If the prescription is for more than that amount, they can either:
- Use the copayment to get the quantity allowed
- Pay the pharmacy's retail price for the quantity that's more than the allowed limit
Level Changes. Level changes are also known as "copayment tier" changes. Starting on January 1, 2011, some medications are moving to a different level. As a result, members may incur higher copayments.
How are we notifying members of these changes?
Members who currently use a medication that is changing on January 1, 2011 will receive a letter from Humana explaining how changes will impact them. If members have questions about their prescription drug benefits or need to find out about other alternatives or medications, they can log on to Humana.com. They can also call the Humana Customer Service number on the back of their Humana ID cards.
