Pharmacy Coverage
Managing your medicines can be a lot of work. We want to make it easier. Learn what medicines your plan covers and where to get them.
Humana Fully-Integrated D-SNP
What drugs are covered?
Your Virginia D-SNP plan covers a full range of safe and effective medicines. These medicines are part of a formulary, or Prescription Drug Guide (PDG). The medicines on the PDG are available at no cost to you.
Your doctor will use the PDG to choose the best medicine to treat you and your condition.
Some medicines on the PDG may be limited or require approval. This approval is known as prior authorization. If a medicine requires prior authorization, your healthcare provider can help you.
View printable copies of the Prescription Drug Guide and pharmacy policies:
2025
2026
Coming soon
Prior authorization
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.
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 - 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.
Where can I get my medicine?
You will need to fill your prescription at a Humana network pharmacy. If you use an out-of-network pharmacy for any reason, you will have to pay the full cost of your medicine.
Find a pharmacy
To fill a prescription, you can go to one of the many pharmacies that accepts your Humana D-SNP. Not sure where to go? Find an in-network pharmacy near you using our find a pharmacy service.
How much will I pay for my medicine?
There are two ways to learn what you will pay for your Medicare Part D prescriptions:
Sign in to your MyHumana account 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.
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.
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
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.
Humana Healthy Horizons in Virginia
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