Pharmacy

Learn what medicines are covered on your Humana Health Plan as well as how to find a pharmacy, get forms and more.

A doctor writes out a prescription at a pharmacy counter next to a girl sitting on the counter.

Find the medicines you need

Keeping track of your medicine is important. We want you to feel comfortable knowing that your prescription coverage is there for you.

What medicines are covered?

Your Humana Medical Plan covers a full range of safe and effective medicines. These medicines are part of a formulary, or Preferred Drug List (PDL). Depending on your plan, the medicines on the PDL may require a copayment—also called a copay.

What will be my copay?

If you have a copay, the information below should help you know what to expect.

  • Generic drugs: $1 copay for a monthly supply
  • Brand drugs: $4 copay for a monthly supply

Products in the classes below are exceptions to the brand/generic rules and will have different copays:

  • Atypical antipsychotics: $1.00 copay
  • Long-acting injectable antipsychotics: $1.00 copay
  • Contraceptives for family planning: $0.00 copay
  • Tobacco cessation: $0.00 copay

Diabetes supplies will have exceptions to the brand/generic rules and will have copays as follows:

  • Blood glucose meters and supplies: $0.00 copay

Your doctor will use the PDL to choose the best medicine for you.

Humana will cover your use of a medicine from the PDL as long as there is a medical need for you to take it. You also need to fill your prescription at a Humana network pharmacy and follow other plan rules.

Find the PDL

Prior authorizations

Getting medicines that are not on the PDL will take extra steps in order to be covered (also known as prior authorization).

Check the PDL to see which medicines need prior authorization, or learn more about how we decide if a medicine will be covered, opens new window.

How to get prior authorization

Ask your doctor to send a request to Humana’s Clinical Pharmacy Review department by phone or online. Only your doctor can send a prior authorization request for you. We will let your doctor know our decision within 24 hours.

Get help with prior authorizations

If you need prior authorization for a prescription, your doctor can contact Humana’s Clinical Pharmacy Review (HCPR).

By phone:

1-800-555-CLIN (2546) (TTY: 711)

Available Monday – Friday, 8 a.m. – 6 p.m., Eastern time.

By fax or mail:

Your doctor can visit our provider prior authorization page to complete the prior authorization form. They may need to include a statement of medical necessity, specific patient medical information, or peer-reviewed literature related to the request.

Fax number: 1-877-486-2621

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

Find a pharmacy

If you have a prescription that you need to fill, head to one of the many pharmacies that takes your Humana medical plan.

Not sure where to go? Find an in-network pharmacy near you using our online pharmacy finder tool.

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

Find a pharmacy

You also have the benefit of using Humana’s mail-order pharmacy, Humana Pharmacy®, which allows your medicine to be delivered directly to your home.

Humana Specialty Pharmacy

If you need medicine to treat a complicated or long-lasting condition—examples could be HIV, cancer or multiple sclerosis—you may need to get your prescription filled at a specialty pharmacy.

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

You can use the pharmacy finder tool to find a specialty pharmacy near you. However, as a Humana member, you have access to the Humana Specialty Pharmacy® that will fill your specialty prescriptions for you and send them to your house directly by mail.

For more information, call:

Humana Specialty Pharmacy

1-800-486-2668 (TTY: 711)

Available Monday – Friday, 8 a.m. – 8 p.m.; Saturday, 8 a.m. – 6 p.m.; Eastern time.

To find all specialty pharmacies in our network:

Find a pharmacy

Medication therapy management

Medication Therapy Management (MTM) is a program that seeks to enhance your medication therapy and to minimize adverse drug reactions. Humana’s MTM program uses a variety of resources, such as telephone-based and pharmacy-based consultation services, for ambulatory and institutional beneficiaries. Humana works with community pharmacies to provide eligible Medicaid members with a series of face-to-face MTM consultations at their local pharmacies.

Lock-in program

Humana’s lock-in program is designed to care for your safety in the event there is an excessive use of prescription drugs. If you qualify for the program, we will work with you and your provider to have your prescriptions transferred to one pharmacy.

If you have any questions please contact us:

  • Phone: 1-855-330-8054, 7:00 a.m. to 4:30 p.m., Central time.
    After hours, please leave a voicemail with the member name, Humana member ID number, case number, contact phone number and a detailed description of your request.
  • Fax: 1-855-729-9290
  • Email: pharmacyclaimauditandreview@humana.com

If you paid out of pocket

We hope you don’t have to pay for any medicines out of pocket. If it happens, let us know by filling out a reimbursement claim form, and you may get a refund.

Fill in the Prescription Drug Claim Form for Member Reimbursement to send a reimbursement claim.

Find documents and forms

More medicine resources

Pharmacy and therapeutics

The pharmacy and therapeutics (P&T) committee meets to make recommendations regarding the Humana preferred drug list (PDL). If you would like to learn more you can find details about the pharmacy and therapeutics meetings.

Looking for help?

Contact us

If you have questions, find the number you need to get help and support.

Find a doctor

Find a doctor, hospital or pharmacy.

Documents & forms

Find the documents and forms you need, including your Enrollee Handbook.