Do you need prior approval?

To get the most value from your benefits, know when your plan requires approval in advance. This step is called "prior authorization" or "preauthorization."

Prescription drugs

Certain drugs require your doctor to get approval before they're covered. This process helps make sure you receive the right medicine in the correct dose, which is very important if you're taking a specialty drug. These medicines are only approved for specific conditions and usually require keeping in close touch with your doctor. Prior authorization takes the extra step to watch specialty drugs.

To find out if a certain 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 member ID card.

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 am to 6 pm local time, or in your local time zone, Monday through Friday.
  • Fax or mail the form — The provider must complete the Prior Authorization form below 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 P. O. Box 33008 Louisville, KY 40232-3008

Prior Authorization fax form (34 KB) Download PDF English

Healthcare services

For certain procedures and services, your doctor or hospital needs to get advanced approval before your plan will cover any of the costs. This is called "prior authorization" or "preauthorization." In most cases, providers and facilities can submit preauthorization requests to Humana using secure technology. As an alternative, they can call a toll-free number and use our interactive voice response (IVR) service.

For details about which healthcare services require preauthorization, check the preauthorization and notification lists below. Some employer groups for which Humana provides administrative services only (self-insured and employer-sponsored programs) may customize their plans with different requirements.

January 24, 2010, Commercial Preauthorization and Notification List (97 KB) Download PDF English

July 10, 2009, Commercial Preauthorization and Notification List (92 KB) Download PDF English

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