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.
Phone & Fax Requests:
| Hours: | 8:00 a.m. – 6:00 p.m. EST, Monday-Friday. |
|---|---|
| Phone Requests: | 866-488-5991 |
| Fax Requests: | Complete the forms below and fax to 866-423-0486 |
General Fax Form
- If a drug does not have a custom form below, please use the General Fax Form.
- (44 KB) Download PDF
- English
Customized Fax Forms
| Aciphex |
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|---|---|
| Actimmune |
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| Actiq |
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| Adcirca |
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| Allegra |
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| Allegra-D |
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| Amevive |
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| Amrix |
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| Anzemet |
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| Apokyn |
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| Aranesp |
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| Arcalyst |
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| Arixtra |
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| Arthrotec |
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| Avonex |
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| Banzel |
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| Betaseron |
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| Boniva |
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| Brovana |
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| Byetta |
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| Celebrex |
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| Cesamet |
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| Cimzia |
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| Clarinex |
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| Clarinex-D |
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| Copaxone |
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| Copegus |
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| Degarelix |
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| Eligard |
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| Embeda |
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| Enbrel |
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| Epogen |
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| Euflexxa |
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| Exjade |
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| Fareston |
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| Fentora |
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| Fibricor |
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| Flector |
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| Flolan |
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| Fosrenol |
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| Forteo |
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| Fragmin |
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| Genotropin (ADULT) |
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| Genotropin (PEDIATRIC) |
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| Gleevec |
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| Hemophilia |
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| Humatrope |
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| Humira |
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| Hyalgan |
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| Increlex |
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| Infergen |
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| Intron A |
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| Innohep |
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| Iplex |
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| IVIG medications |
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| Janumet |
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| Januvia |
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| Kepivance |
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| Keppra XR |
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| Ketek |
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| Kineret |
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| Kuvan |
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| Kytril |
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| Lamisil |
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| Letairis |
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| Leukine |
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| Lovenox |
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| Lucentis |
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| Lyrica |
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| Macugen |
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| Mepron |
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| Moxatag |
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| Mozobil |
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| Multaq |
|
| Multi-Source Brand-Name Review Request |
|
| Neulasta |
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| Neupogen |
|
| Nexavar |
|
| Nexium |
|
| Nonformulary |
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| Norditropin (ADULT) |
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| Norditropin (PEDIATRIC) |
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| Noxafil |
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| Nplate |
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| Nutropin (ADULT) |
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| Nutropin (PEDIATRIC) |
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| Omnitrope (ADULT) |
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| Omnitrope (PEDIATRIC) |
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| Orencia |
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| Orthovisc |
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| Ozurdex |
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| Pegasys |
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| Peg-Intron |
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| Penlac |
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| Prevacid |
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| Prilosec |
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| Procrit |
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| Promacta |
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| Protonix |
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| Provigil |
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| Rebif |
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| Rebetol |
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| Reclast |
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| Relistor |
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| Remicade |
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| Remodulin |
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| Revatio |
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| Revlimid |
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| RibaPak |
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| Ribasphere |
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| RibTab |
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| Ribavirin |
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| Rituxan |
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| Saizen |
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| Sandostatin |
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| Sandostatin LAR |
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| Saphris |
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| Savella |
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| Sensipar |
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| Serostim (ADULT) |
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| Serostim (PEDIATRIC) |
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| Simcor |
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| Simponi |
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| Somatuline Depot |
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| Somavert |
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| Soriatane |
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| Sporanox |
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| Sprycel |
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| Supartz |
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| Sutent |
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| Symlin |
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| Synvisc |
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| Tarceva |
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| Targretin |
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| Tasigna |
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| Tasmar |
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| Tekturna |
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| Tev-Tropin (ADULT) |
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| Tev-Tropin (PEDIATRIC) |
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| Thalomid |
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| Tobi |
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| Tracleer |
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| Trelstar |
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| Trilipix |
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| Tykerb |
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| Tysabri |
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| Uloric |
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| Vantas |
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| Vectibix |
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| Ventavis |
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| Vidaza |
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| Virazole |
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| Visudyne |
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| Vivitrol |
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| Xenazine |
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| Xifaxan |
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| Xolair |
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| Zegerid |
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| Zetia |
|
| Zofran |
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| Zoladex |
|
| Zolinza |
|
| Zorbtive (ADULT) |
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| Zorbtive (PEDIATRIC) |
|
| Zyvox |
|
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