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."
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:
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
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
* Websites accessible from Humana.com may provide information about current medical procedures, services, pharmaceuticals, medical devices, and other treatment and therapies that may not be covered under your health plan. The information on these sites does not necessarily represent the views of Humana, nor should the information be construed as an endorsement by Humana. The information on these websites is not a substitute for professional healthcare. For personal medical guidance, please consult your physician. If you have questions about your Humana health plan benefits, please call Humana Customer Service at the number on your member ID card.