Submitting a Request for Prior Authorization
Prescribers can submit their requests to Humana Clinical Pharmacy Review (HCPR) through the following methods:
Phone requests: Call 1-866-488-5991 between 8 a.m. and 6 p.m. local time, Monday through Friday, to submit a request by telephone.
Fax requests: Complete the applicable form below and fax it to 1-855-681-8650.
To obtain the status of a prior request or for general information, you may contact HCPR by calling 1-866-488-5991 Monday through Friday, 8 a.m. to 6 p.m. local time.
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
- (105 KB) 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.
- High-Risk Medications (HRM)
- (211 KB) Download PDF. Use this fax form to request use of medications identified by the Beer's criteria as potentially high risk and inappropriate for use in the elderly.
- Brand-Name Multisource Authorization (MSB)
- (206 KB) Download PDF. Use this fax form to request use of brand-name medications that have a generic equivalent available.
- Nonformulary Drug Authorization
- (205 KB) Download PDF. Use this fax form to request use of medications not on the member's formulary.
- Prescriber Quick Reference Guide
- (276 KB) Download PDF. This guide helps prescribers determine which Humana medication resource to contact for prior authorization, step therapy, quantity limits, medication exceptions, appeals, precertification and claims. It also provides applicable phone, fax and Web contact information.
Universal Fax Forms
If a specific fax form for the medication being requested is not located above, please use the appropriate universal fax form below.
Universal B vs. D Drug Authorization Request
Universal Fax Form
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