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Pharmacy Eligibility Requirements

Pharmacies interested in participating in our Medication Therapy Management pharmacy network must meet the criteria below.

MTM participating pharmacy eligibility criteria:

  1. The pharmacy must have an existing contract with Humana and have accepted (or be in the process of accepting) the 2006 Medicare amendments. If you have any questions or concerns about the status of your Humana contract, please fax your questions to 502-580-2200. Please include the pharmacy name, National Association of Boards of Pharmacy (NABP) number, contact name, phone number, and fax number on the request.
  2. The pharmacy must have a private or semiprivate area to provide MTM consultations.
  3. The pharmacy must be able to submit MTM claims using the MTM CPT codes and NCPDP 5.1 Professional Pharmacy Service codes.
  4. Pharmacists providing MTM must attest to having a strong understanding of the following standards of care guidelines:
    1. National Cholesterol Education Program Guidelines (NCEP)
    2. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7)
    3. American Diabetes Association (ADA) Guidelines
    4. American Geriatrics Society Clinical Practice Guidelines
    5. Beers Criteria for Potentially Inappropriate Medications Used in Older Adults
  5. The pharmacy must have e-mail capabilities and be able to receive member-specific medication information required for consultations.

Consulting and clinical pharmacist eligibility criteria:

Consulting pharmacists and clinical pharmacists interested in participating in Humana's MTM pharmacy network must meet the following eligibility criteria:

  1. Pharmacists providing MTM must attest to having a strong understanding of the following standards of care guidelines:
    1. National Cholesterol Education Program Guidelines (NCEP)
    2. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7)
    3. American Diabetes Association (ADA) Guidelines
    4. American Geriatrics Society Clinical Practice Guidelines
    5. Beers Criteria for Potentially Inappropriate Medications Used in Older Adults
  2. Pharmacists not affiliated with a dispensing pharmacy must be willing to independently contract with local pharmacies to provide MTM consultations, as Humana will only be accepting MTM claims submitted using the NCPDP system.

If you meet the eligibility criteria above and want to join Humana's MTM provider network, simply download, complete, and return this form:

MTM Fax Form
(49 KB) Download PDF
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