Prior Authorizations

Certain prescription drugs require prior authorization or a medical exception for coverage. If your drug requires this step, your doctor will need to request and receive approval from Humana before the drug will be covered under your insurance plan.

Why is prior authorization required?

Select high-risk or high-cost medications require prior authorization by the Humana Clinical Pharmacy Review (HCPR) to be eligible for coverage. This is to ensure that the drugs are used properly and in the most appropriate circumstances. Prior authorization criteria are established by Humana's Pharmacy and Therapeutics committee with input from providers, manufacturers, peer-reviewed literature, standard compendia, and other experts.

How to get prior authorization for your prescription

In order for you to receive coverage for a medication requiring prior authorization, follow these steps:

    1. Use the Drug List Search to determine if your prescription drug requires prior authorization for coverage.
    3. Once your request has been processed, your doctor will be notified. If you are a Medicare member, you will also receive a determination letter in the mail.