November 28, 2011
The Pharmacy & Therapeutics Committee reviews and updates the drug list on an annual basis to ensure that drugs are placed in the most appropriate and cost-effective level. Changes are implemented to help ensure safety and control cost, as well as minimize fraud, waste, and abuse.
Before the plan pays for certain medications, the doctor must get advance approval from Humana. This is called "prior authorization." Without prior authorization, the pharmacy cannot fill the prescription. Doctors can get prior authorization by faxing a request form to Humana's Clinical Pharmacy Review department.
Quantity limits are the maximum amount of a medicine Humana will cover for the copayment. Starting on Jan. 1, 2012, if members fill or refill a prescription for any medicine with quantity limits, they can get up to the quantity limit. If the prescription is for more than that amount, they can either:
Level changes are also known as "copayment tier" changes. Starting on Jan. 1, 2012, some medications are moving to a different level. As a result, members may incur higher copayments.
Members who currently use a medication that is changing on Jan. 1, 2012, will receive a letter from Humana explaining how changes will impact them. If members have questions about their prescription drug benefits, or need to find out about other alternatives or medications, they can log on to Humana.com. They can also call the Humana Customer Service number on the back of their Humana ID cards.
For more information, contact your Humana representative today.