Prior Authorization

Certain drugs require prior authorization (PA) or a medical exception for coverage. If the drug requires this step, a member’s doctor will need to request and receive approval from Humana before the drug may be covered by their insurance plan.

Instructions for: United States | Puerto Rico

Request Submission

Doctors can submit their requests to the Humana Clinical Pharmacy Review (HCPR) through the following methods.

Online Requests:

Requests can be submitted in real-time, 24-hours a day using Humana’s Online Prior Authorization Tool. Log in to use our Online PA Tool.

Submit Requests Online

Providers can submit PA requests by using our Online PA Tool.

Phone & Fax Requests:

Hours:	8:00 a.m. – 9:00 p.m. EST, Monday-Friday.
Phone Requests:	1-800-555-CLIN (2546)
Fax Requests:	Complete the forms below and fax to 1-877-486-2621

General Fax Form

If a drug does not have a custom form below, please use the General Fax Form or Submit online.

Customized Fax Forms

Aciphex	Download Fax Form	Submit online
Actiq	Download Fax Form
Actimmune	Download Fax Form
Allegra	Download Fax Form
Allegra-D	Download Fax Form
Amevive	Download Fax Form
Amrix	Download Fax Form
Antagon	Download Fax Form
Aralast	Download Fax Form
Aranesp	Download Fax Form
Arranon	Download Fax Form
Avonex	Download Fax Form	Submit online
Betaseron	Download Fax Form	Submit online
Boniva	Download Fax Form
Bravelle	Download Fax Form
Byetta	Download Fax Form	Submit online
Bystolic	Download Fax Form
Celebrex	Download Fax Form	Submit online
Cetrotide	Download Fax Form
Clarinex	Download Fax Form
Clarinex-D	Download Fax Form
Copaxone	Download Fax Form
Coreg CR	Download Fax Form	Submit online
Eligard	Download Fax Form
Enbrel	Download Fax Form
Epogen	Download Fax Form
Euflexxa	Download Fax Form
Fentora	Download Fax Form
Flector	Download Fax Form
Flolan	Download Fax Form
Forteo	Download Fax Form
Fosrenol	Download Fax Form
Genotropin	Download Fax Form
Gleevec	Download Fax Form
Gonal-F	Download Fax Form
HCG (human chorionic gonadotropin)	Download Fax Form
Hemophilia	Download Fax Form
Herceptin	Download Fax Form
Humatrope	Download Fax Form
Humira	Download Fax Form
Hyalgan	Download Fax Form
Increlex	Download Fax Form
Iplex	Download Fax Form
IVIG medications	Download Fax Form
Janumet	Download Fax Form	Submit online
Januvia	Download Fax Form	Submit online
Kineret	Download Fax Form
Lamisil	Download Fax Form	Submit online
Letairis	Download Fax Form
Leukine	Download Fax Form
Lucentis	Download Fax Form
Lupron	Download Fax Form
Lupron (Infertility)	Download Fax Form
Luveris	Download Fax Form
Neulasta	Download Fax Form
Neupogen	Download Fax Form
Nexavar	Download Fax Form
Nexium	Download Fax Form	Submit online
Norditropin	Download Fax Form
Noxafil	Download Fax Form
Nutropin	Download Fax Form
Orencia	Download Fax Form
Orthovisc	Download Fax Form
Ovidrel	Download Fax Form
Pegasys	Download Fax Form
Peg-Intron	Download Fax Form
Penlac	Download Fax Form	Submit online
Prevacid	Download Fax Form	Submit online
Prilosec	Download Fax Form	Submit online
Procrit	Download Fax Form
Progesterone in Sesame Oil	Download Fax Form
Prolastin	Download Fax Form
Protonix	Download Fax Form	Submit online
Provigil	Download Fax Form
Raptiva	Download Fax Form
Rebif	Download Fax Form	Submit online
Reclast	Download Fax Form
Remicade	Download Fax Form
Remodulin	Download Fax Form
Repronex	Download Fax Form
Revatio	Download Fax Form
Revlimid	Download Fax Form
Ribavirin	Download Fax Form
Rituxan	Download Fax Form
Saizen	Download Fax Form
Sandostatin	Download Fax Form
Sandostatin LAR	Download Fax Form
Serostim	Download Fax Form
Simcor	Download Fax Form
Soliris	Download Fax Form
Somavert	Download Fax Form
Sporanox	Download Fax Form	Submit online
Sprycel	Download Fax Form
Supartz	Download Fax Form
Sutent	Download Fax Form
Symlin	Download Fax Form
Synagis	Download Fax Form
Synvisc	Download Fax Form
Tekturna	Download Fax Form
Tev-Tropin	Download Fax Form
Thalomid	Download Fax Form
Tobi	Download Fax Form
Tracleer	Download Fax Form
Trelstar	Download Fax Form
Tykerb	Download Fax Form
Tysabri	Download Fax Form
Vectibix	Download Fax Form
Ventavis	Download Fax Form
Vidaza	Download Fax Form
Vivitrol	Download Fax Form
Xolair	Download Fax Form
Xyzal	Download Fax Form
Zegerid	Download Fax Form	Submit online
Zemaira	Download Fax Form
Zoladex	Download Fax Form
Zolinza	Download Fax Form
Zyrtec	Download Fax Form
Zyrtec D	Download Fax Form

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