A Humana provider taking a patients blood pressure.

Precertification

Some drugs require precertification before they can be delivered or administered in a physician’s office, clinic, outpatient or home setting. Precertification is required for the drugs listed below.

Request Submission

Doctors can submit their requests to the Medical Intake Team (MIT) through the following method:

Fax Requests

Complete the applicable form below and fax it to 1-888-447-3430.

To obtain the status on a request or for general information, you may contact MIT by calling 1-866-461-7273 Monday through Friday, 8:00 AM to 6:00 PM local time.

Prescriber Quick Reference Guide

This guide helps prescribers determine which Humana medication resource to contact for precertification, step therapy, quantity limits, medication exceptions, appeals, prior authorization and claims, along with applicable phone, fax or Web contact information.

Prescriber Quick Reference Guide Form
(0.2 MB) Download PDF
English

Fax Forms

Self-Administered Injectable
(422 KB) Download PDF
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Universal B vs. D Medical Fax Form
(452 KB) Download PDF
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Universal Medical Fax Form
(431 KB) Download PDF
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Customized Fax Forms

Abraxane
(467 KB) Download PDF
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Actemra
(498 KB) Download PDF
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Adcetris
(477 KB) Download PDF
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Afinitor
(466 KB) Download PDF
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Aldurazyme
(456 KB) Download PDF
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Alimta
(540 KB) Download PDF
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Aloxi IV injection
(498 KB) Download PDF
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Amevive
(439 KB) Download PDF
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Aralast-NP
(438 KB) Download PDF
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Aranesp
(537 KB) Download PDF
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Arcalyst
(447 KB) Download PDF
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Arranon
(512 KB) Download PDF
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Arzerra
(467 KB) Download PDF
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Atgam
(477 KB) Download PDF
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Avastin
(552 KB) Download PDF
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Avonex
(478 KB) Download PDF
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Benlysta
(501 KB) Download PDF
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Berinert
(498 KB) Download PDF
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Betaseron
(478 KB) Download PDF
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Bexxar
(471 KB) Download PDF
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Boniva IV
(482 KB) Download PDF
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Botox
(518 KB) Download PDF
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Brovana
(432 KB) Download PDF
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Buprenex
(456 KB) Download PDF
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Caprelsa
(430 KB) Download PDF
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Ceredase
(457 KB) Download PDF
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Cerezyme
(457 KB) Download PDF
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Cimzia
(458 KB) Download PDF
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Cinryze
(498 KB) Download PDF
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Copaxone
(478 KB) Download PDF
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Cyklokapron
(455 KB) Download PDF
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Cytogam
(458 KB) Download PDF
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Dacogen
(490 KB) Download PDF
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Dysport
(518 KB) Download PDF
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Elaprase
(467 KB) Download PDF
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Elitek
(430 KB) Download PDF
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Ellence
(430 KB) Download PDF
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Eloxatin
(430 KB) Download PDF
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Emend IV
(493 KB) Download PDF
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Enbrel
(477 KB) Download PDF
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Epogen
(537 KB) Download PDF
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Erbitux
(505 KB) Download PDF
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Erwinaze
(474 KB) Download PDF
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Extavia
(478 KB) Download PDF
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Eylea
(469 KB) Download PDF
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Fabrazyme
(448 KB) Download PDF
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Firazyr
(453 KB) Download PDF
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Flolan
(496 KB) Download PDF
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Folotyn
(450 KB) Download PDF
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Forteo
(461 KB) Download PDF
English
Fusilev
(474 KB) Download PDF
English
Genotropin (ADULT)
(506 KB) Download PDF
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Genotropin (PEDIATRIC)
(490 KB) Download PDF
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Gilenya
(459 KB) Download PDF
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Glassia
(438 KB) Download PDF
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Gleevec
(486 KB) Download PDF
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Halaven
(469 KB) Download PDF
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Herceptin
(474 KB) Download PDF
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Humatope (ADULT)
(506 KB) Download PDF
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Humatope (PEDIATRIC)
(490 KB) Download PDF
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Humira
(511 KB) Download PDF
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Ilaris
(474 KB) Download PDF
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Immune Globulin
(584 KB) Download PDF
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Increlex
(501 KB) Download PDF
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Istodax
(474 KB) Download PDF
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Ixempra
(480 KB) Download PDF
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Jakafi
(450 KB) Download PDF
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Jevtana
(478 KB) Download PDF
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Kalbitor
(463 KB) Download PDF
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Kineret
(456 KB) Download PDF
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Krystexxa
(471 KB) Download PDF
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Lucentis
(478 KB) Download PDF
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Lumizyme
(454 KB) Download PDF
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Macugen
(473 KB) Download PDF
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Makena
(453 KB) Download PDF
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Mozobil
(481 KB) Download PDF
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Myobloc
(518 KB) Download PDF
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Myozyme
(454 KB) Download PDF
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Naglazyme
(441 KB) Download PDF
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Neulasta
(485 KB) Download PDF
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Nexavar
(470 KB) Download PDF
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Norditropin (ADULT)
(506 KB) Download PDF
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Norditropin (PEDIATRIC)
(490 KB) Download PDF
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Nplate
(491 KB) Download PDF
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Nulojix
(471 KB) Download PDF
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Nutropin (ADULT)
(506 KB) Download PDF
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Nutropin (PEDIATRIC)
(490 KB) Download PDF
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Omnitrope (ADULT)
(506 KB) Download PDF
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Omnitrope (PEDIATRIC)
(490 KB) Download PDF
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Orencia
(482 KB) Download PDF
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Ozurdex
(472 KB) Download PDF
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Pegasys
( KB) Download PDF
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Peg-Intron
(519 KB) Download PDF
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Prialt
(462 KB) Download PDF
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Procrit
(521 KB) Download PDF
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Prolastin-C
(438 KB) Download PDF
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Prolia
(478 KB) Download PDF
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Provenge
(475 KB) Download PDF
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Qutenza
(449 KB) Download PDF
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Rebif
(478 KB) Download PDF
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Reclast
(500 KB) Download PDF
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Relistor
(457 KB) Download PDF
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Remicade
(506 KB) Download PDF
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Remodulin
(496 KB) Download PDF
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Revatio
(496 KB) Download PDF
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Revlimid
(471 KB) Download PDF
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Rituxan
(514 KB) Download PDF
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Saizen (ADULT)
(506 KB) Download PDF
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Saizen (PEDIATRIC)
(490 KB) Download PDF
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Sandostatin LAR
(599 KB) Download PDF
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Serostim (ADULT)
(506 KB) Download PDF
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Serostim (PEDIATRIC)
(490 KB) Download PDF
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Simponi
(476 KB) Download PDF
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Soliris
(467 KB) Download PDF
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Somatuline Depot
(474 KB) Download PDF
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Somavert
(454 KB) Download PDF
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Sprycel
(466 KB) Download PDF
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Stelara
(475 KB) Download PDF
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Sutent
(479 KB) Download PDF
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Sylatron
(459 KB) Download PDF
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Synagis
(484 KB) Download PDF
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Tarceva
(478 KB) Download PDF
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Targretin
(458 KB) Download PDF
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Tasigna
(456 KB) Download PDF
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Tev-Tropin (ADULT)
(506 KB) Download PDF
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Tev-Tropin (PEDIATRIC)
(490 KB) Download PDF
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Thalomid
(472 KB) Download PDF
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Torisel
(490 KB) Download PDF
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Treanda
(501 KB) Download PDF
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Tykerb
(463 KB) Download PDF
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Tyvaso
(496 KB) Download PDF
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Valstar
(461 KB) Download PDF
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Vectibix
(485 KB) Download PDF
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Velcade
(513 KB) Download PDF
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Ventavis
(496 KB) Download PDF
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Vidaza (injection)
(498 KB) Download PDF
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Visudyne
(473 KB) Download PDF
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Vivitrol
(465 KB) Download PDF
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Votrient
(459 KB) Download PDF
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Vpriv
(470 KB) Download PDF
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Xalkori
(479 KB) Download PDF
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Xeloda
(669 KB) Download PDF
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Xeomin
(518 KB) Download PDF
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Xgeva
(485 KB) Download PDF
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Xolair
(503 KB) Download PDF
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Yervoy
(502 KB) Download PDF
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Zelboraf
(457KB) Download PDF
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Zemaira
(438 KB) Download PDF
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Zevalin
(447 KB) Download PDF
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Zolinza
(463 KB) Download PDF
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Zometa
(511 KB) Download PDF
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Zorbtive (ADULT)
(506 KB) Download PDF
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Zorbtive (PEDIATRIC)
(490 KB) Download PDF
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Zyprexa Relprevv
(428 KB) Download PDF
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Zytiga
(465 KB) Download PDF
English