You may need to get approval before you can get a certain medicine. This approval is also known as prior authorization.

Whether a medicine needs this approval or not may change. Check the Humana Drug List opens in new window to see which medicines need prior authorization.

How to get prior authorization

 To receive coverage for a medication requiring prior authorization, you can:

• Ask your healthcare provider to submit the request. Your healthcare provider can submit the request online, by fax or phone. Once your request has been processed, your healthcare provider will be notified. If you are a Medicare member, you will also receive a determination letter in the mail.
• Submit your own prior authorization request. You can complete your own request in 3 ways:
  • Submit an online request for Part D prior authorization opens in new window
  • Download, fill out and fax the Medicare Prescription Drug Coverage Determination form  to 877-486-2621
  • Call 800-555-CLIN (2546), Monday – Friday, 8 a.m. – 8 p.m., local time.

Learn more about prior authorization

There are two ways to learn what you will pay for your Medicare Part D prescriptions:

• Sign in to your MyHumana account opens in new window  to price a drug based on your plan.
• Find the What is my copay? section in the Prescription Drug Guide, or look for more information in your Explanation of Coverage (EOC)

Medicare Prescription Payment Plan (MPPP)

Eligible Part D enrollees can pay out-of-pocket prescription drug costs in monthly payments instead of all at once. This program does not save you money or lower your drug costs—it’s a monthly installment payment plan.

Learn more about the Medicare Prescription Payment Plan

What if I paid out of pocket?

We hope you don’t have to pay for any medicines out of pocket. If you do, let us know by filling out a Pharmacy Direct Member Reimbursement form, and you may get a refund.

Fill out the Pharmacy Direct Member Reimbursement form pdf opens in new window  to file a reimbursement claim.

Mail the form to:

Humana Pharmacy Operations
P.O. Box 14359
Lexington, KY 40512

Medication Therapy Management

Medication Therapy Management (MTM), is a Medicare-designed program that Humana offers to eligible  DSNP members. This program allows you to get a 1-on-1 review of your medications with a qualified pharmacist or other trained healthcare provider. We can help you make sure your medications are working for you, identify any potential lower-cost options and answer any questions or concerns you may have about your medications.

If you have questions about our Medicine Therapy Management program, call our partner organization MedWatchers at 833-677-4088 (TTY: 771), Monday – Friday 8am – 9pm, EST

Learn more about Medication Therapy Management and find out if you qualify

Questions?

If you have any questions about your pharmacy benefits, call Customer Care at 844-881-4482 (TTY:711), Monday – Friday, 8 a.m. – 8 p.m., Eastern time.