Pharmacy

We know understanding your pharmacy/medicine coverage is important. As a Humana Healthy Horizons™ in Kentucky enrollee, your pharmacy coverage includes access to many safe and effective medicines. These medicines are part of a formulary, also known as the Kentucky Medicaid Single Preferred Drug List (PDL). Your doctor will use the PDL to choose the best medicine for you.

We cover medicine from the PDL that you need if:

• There is a medical need for you to take it
• You fill your prescription at a Humana network pharmacy
• Follow other plan rules

Check the lists below to see the medicines your plan covers.

Humana Healthy Horizons in Kentucky PDL (English), PDF opens new window

Humana Healthy Horizons in Kentucky PDL (Spanish), PDF opens new window

The Kentucky Department for Medicaid Services also makes a PDL available for all Medicaid enrollees, regardless of health plan.

Kentucky Medicaid Single PDL, PDF opens new window

You can click on each of the above links to review, download, and print that specific PDF.

In addition, many medications have Quantity Level Limits (QLLs) for per day/month use. Information about these limits is available as a PDF, opens new window that you can review, download, and print.

As of July 1, 2021, MedImpact will begin administering pharmacy benefits for all Medicaid enrollees in Kentucky, including Humana Healthy Horizons in Kentucky enrollees. All pharmacy benefits will remain the same and you do not have to do anything. All of our covered households received a letter about this change. Below, you’ll also find a link to the letter we sent enrollees.

Pharmacy program changes effective July 1, 2021, PDF opens new window

You may need to get approval before getting medicine not on the PDL. This pre-approval is called prior authorization.

To learn more about prior authorization:

• Refer to your Enrollee Handbook
• Call Enrollee Services at 1-800-444-9137 (TTY: 711), Monday – Friday, 7 a.m. – 7 p.m., Eastern time

The PDL includes information about:

• The medicines that need prior authorization
• How we decide if we will cover a medicine

How to get prior authorization

Ask your doctor to send a request by phone or online to our Clinical Pharmacy Review department. Your doctor can reach our Clinical Pharmacy Review department:

By phone: 1-800-555-CLIN (2546) (TTY: 711), Monday – Friday, 8 a.m. – 6 p.m., Eastern time.

By fax or mail:

To submit a prior authorization by fax or mail, your doctor must:

• Visit our provider prior authorization page to complete a prior authorization form
• Print the completed form, and any related information (e.g., statement of medical necessity, specific patient medical information, peer-reviewed literature, etc.)

Your doctor can fax the form and related paperwork to:

1-877-486-2621

Your doctor can mail the form and related paperwork to:

Humana Pharmacy Operations
P.O. Box 33008
Louisville, KY 40232-3008.

Only your doctor can send a prior authorization request for you. We will let your doctor know our decision within 24 hours.

You can fill your prescriptions at any pharmacy that accepts Humana Healthy Horizons in Kentucky.

Not sure where to go? Use our online Find a Pharmacy service to find an in-network pharmacy.

You also can use Humana’s mail-order pharmacy, Humana Pharmacy^®, which will send your medicines to your home.

Note: If you use an out-of-network pharmacy for any reason, you’ll have to pay the full cost of your medicine.

If you need medicine to treat a complicated or long-lasting condition – such as cancer, HIV, or multiple sclerosis – you may need a specialty pharmacy to fill your prescription.

There are specialty prescriptions that only certain locations will have in stock.

Use our Find a Pharmacy service to find a specialty pharmacy near you.

You also have the benefit of using Humana’s mail-order pharmacy, Humana Specialty Pharmacy^®, which will send your medicines to your home.

For more information, call the Humana Specialty Pharmacy at 1-800-486-2668 (TTY: 711), Monday – Friday, 8 a.m. – 8 p.m., Eastern time, and Saturday, 8 a.m. – 6 p.m., Eastern time.

If you’re taking multiple medicines prescribed by more than one doctor, your medicines, when combined, may:

• Reduce the effectiveness of your medicine
• Cause severe side effects
• Cost you more money per month

As part of your Humana Healthy Horizons in Kentucky coverage, you can set up a one on one review of your medicines with a pharmacist. This free review is called Medication Therapy Management (MTM).

We designed our lock-in program to help our enrollees who take several prescription medicines. If you qualify for the program, to make filling your prescriptions as easy as possible, we will work with you and your provider to have your prescriptions transferred to one pharmacy.

If you have any questions please contact us by:

• Phone: 1-855-330-8054, 7 a.m. – 4:30 p.m., Central time
  After hours, please leave a voicemail with the enrollee name, Humana enrollee ID number, case number, contact phone number, and a detailed description of your request.
• Fax: 1-855-729-9290
• Email: pharmacyclaimauditandreview@humana.com

Drug dictionary – information about medicines

Save with generic medicine

Tips for avoiding dangerous drug interactions

We hope you don’t have to pay for any medicines out of pocket. If you do, fill out and send us a Prescription Drug Reimbursement Claim Form, and you may get a refund. We make the Prescription Drug Reimbursement Claim Form available in English, opens new window and in Spanish, opens new window

The Department for Medicaid Services conducts pharmacy and therapeutics (P&T) committee meetings. This committee meets throughout the year to make recommendations about the single Preferred Drug List (PDL). The Department makes information available on its website, opens new window about its meetings and decisions.