Certain drugs require your doctor to get approval before they're covered. This process helps make sure you receive the right medicine in the right dose. It also helps keep you safe, which is very important if you're taking a specialty drug. These medicines are only approved for specific conditions and usually require keeping in close touch with your doctor. Prior authorization takes the extra step to watch specialty drugs.
To find out if a certain drug requires prior authorization, you can:
- Search online – Use Humana's Drug List Search
- Call us – Call the Humana Customer Service number on the back of your Humana member ID card.
For drugs that require prior authorization, your doctor must contact Humana Clinical Pharmacy Review (HCPR) in one of these ways:
- Call 1-800-555-CLIN (2546) – Hours are 8 am to 6 pm local time, or in your local time zone, Monday through Friday.
- Fax or mail the form – The provider must complete the form in its entirety, and include a supporting statement of medical necessity. The supporting statement may include specific patient medical information as well as peer-reviewed literature related to the request if applicable.
Fax number: 1-877-486-2621
Humana Clinical Pharmacy Review
P. O. Box 33008
Louisville, KY 40232-3008
- Prior Authorization Fax Form
- (34 KB) Download PDF
For certain procedures and services, your doctor or hospital needs to get advance approval before your plan will cover any of the costs. This is called "prior authorization" or "preauthorization." In most cases, providers and facilities can submit preauthorization requests to Humana using secure technology. As an alternative, they can call a toll-free number and use our interactive voice response (IVR) service.
For details about which healthcare services require preauthorization, check the preauthorization and notification lists below. Some employer groups for which Humana provides administrative services only (self-insured and employer-sponsored programs) may customize their plans with different requirements.
- November 5, 2012 Commercial Preauthorization and Notification List
- (705 KB) Download PDF
- January 24, 2010, Commercial Preauthorization and Notification List
- (97 KB) Download PDF
- July 10, 2009, Commercial Preauthorization and Notification List
- (92 KB) Download PDF