Submitting a Request for Prior Authorization
Prescribers can submit their requests to Humana Clinical Pharmacy Review (HCPR) through the following methods:
Phone requests: 1-800-555-CLIN (2546)
Hours: 8 a.m. to 6 p.m., local time, Monday through Friday
Fax requests: Complete the applicable form below and fax to 1-877-486-2621.
Before submitting a prior authorization request for an elderly patient, please review this list of medications to avoid in the elderly. It is adapted from the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS®) measure, Use of High-Risk Medications in the Elderly.
Coverage Determination Forms
- Request for Coverage Determination
- (0.5 MB) Download PDF
- English | Spanish
If you prefer, you may complete the coverage determination request form online. Before completing the form, you may want to view our accepted file types.
Another option is to use the Coverage Determination Request Form on the CMS website.
Universal Fax Forms
If a specific fax form for the medication being requested is not located above, please use the universal fax form
- Universal
- (110 KB) Download PDF
- English
Note: These documents are in Portable Document Format (PDF) and require Adobe Reader for viewing and printing. To get the plug-in, visit Adobe's Website to Download Adobe Reader
Please note the following regarding medically accepted indications:
All reasonable efforts have been made to ensure consideration of medically accepted indications in this policy. Medically accepted indications are defined by the Centers for Medicare & Medicaid Services (CMS) as those uses of a covered Part D drug that are approved under the Federal Food, Drug, and Cosmetic Act, or the use of which is supported by one or more citations included or approved for inclusion in any of the compendia described in section 1927(g)(1)(B)(i) of the act. These compendia guide review of off-label and off-evidence prescribing and are subject to minimum evidence standards for each compendium. Currently, this review includes the following references when applicable and may be subject to change per CMS:
- American Hospital Formulary Service (AHFS) Compendium
- Thomson Micromedex/DrugDex (not Drug Points) Compendium
- National Comprehensive Cancer Network (NCCN) Drugs and Biologics Compendium™
- Elsevier Gold Standard's Clinical Pharmacology Compendium
