Why is the drug list changing?
Humana Pharmacy Solutions' Pharmacy and Therapeutics Committee reviews and updates the drug list on an annual basis. This ensures that drugs are placed in the most appropriate and cost-effective level. Changes are put in place to help ensure safety and control cost, as well as to reduce fraud, waste, and abuse.
What do these changes mean?
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.
Employees must try one or more alternatives for prescriptions that require step therapy. Sometimes a member's doctor doesn't think the alternative drugs are right for them. In that case, they must request approval from Humana before we'll cover the prescription.
Quantity limits are the maximum amount of a medicine Humana will cover for the copayment. Starting on Jan. 1, 2012, 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 are also known as "copayment tier" changes. Starting on Jan. 1, 2012, some medications are moving to a different level. As a result, members may experience higher copayments.
How are we notifying members of these changes?
Members who currently use a medication that is changing on Jan. 1, 2012, will receive a letter from Humana explaining how changes will affect 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.
For more information, contact your Humana representative today.