Some medications require prior approval

For some medications, you must get approval from Humana before you fulfill the prescription to ensure that your HumanaOne® plan will cover the costs. This is called "prior authorization."

If your plan requires prior authorization, and you do not get an okay from Humana before you fill the prescription, you will be responsible for all charges associated with the medication.

Why does Humana require prior authorization?

This approval process helps ensure you make the best use of your benefits and receive the most appropriate treatment. For example, if you have diabetes, and your doctor wants you to try a new medication, we may need to authorize this drug before you fill the prescription. We want to make sure the medication won't interfere with others you take or add to your costs unnecessarily.

How do I know if a drug requires prior authorization?

You can:
  • Search online –Use Humana's Drug List Search
  • Call us – Call the Humana Customer Service number on the back of your Humana member ID card

How prior authorization works

For drugs that require prior authorization, your doctor must contact Humana Clinical Pharmacy Review (HCPR) in one of these ways:
  • Call 1-800-555-CLIN (2546) – Hours are 8 a.m. to 9 p.m., Eastern time, Monday through Friday.
  • Fax or mail the form – The provider must complete the form in its entirety, and include a supporting statement of medical necessity. The supporting statement may include specific patient medical information as well as peer-reviewed literature related to the request if applicable.

Fax number: 1-877-486-2621
Mailing address:
Humana Clinical Pharmacy Review
1951 Bishop Lane, Suite 500
Louisville, KY 40218

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