When can I appeal an unfavorable drug coverage determination?
If you have received an unfavorable drug determination, you can ask for redetermination (appeal) by following the instructions given in the determination or as outlined below. Some reasons you may want to ask for a redetermination may be for formulary exceptions, coverage rule exceptions, or tiering exceptions.
Can I file an expedited appeal on an unfavorable drug coverage determination?
An expedited appeal can be requested for situations in which the standard resolution timeframe could seriously jeopardize your (member) life or health, or the ability to regain maximum function. Refer to the Expedited Appeal section.
Who can submit the Part D coverage redetermination request?
You (member), a person you appoint, your prescribing doctor, or other prescriber can submit the Part D coverage redetermination request. Refer to the How to Appoint a Representative section for additional information.
How can I submit the reconsideration request?
Before filling out the form, please view our accepted file types.
Fax Number: 1-855-251-7594
Humana Grievances and Appeals
P.O. Box 14165
Lexington, KY 40512-4165
Puerto Rico Members: Use the following form, fax and/or mailing address.
Fax Number: 1-800-595-0462
Humana Puerto Rico
Grievances and Appeals Unit
P.O. Box 191920
San Juan, PR 00919-1920
Be sure to submit all supporting information for your appeal request. You or your prescribing doctor or other prescriber can send this to fax number 1-855-251-7594. If you live in Puerto Rico, please fax to 1-800-595-0462. After we receive the request, Humana will make our decision and send written notice within seven calendar days.
Humana is a Medicare Advantage organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in a Humana plan depends on contract renewal.
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