Prior Authorizations

Before picking up your prescription at the pharmacy, it’s important to find out if it’s covered by your plan even if your doctor has prescribed it. Use MyHumana’s online portal to discover which drugs have a prior authorization, and those that might cost more than you’re willing to pay.

Why is prior authorization required?

Select high-risk or high-cost medications require prior authorization by the Humana Clinical Pharmacy Review (HCPR) to be eligible for coverage. This is to ensure that the drugs are used properly and in the most appropriate circumstances. Prior authorization criteria are established by Humana's Pharmacy and Therapeutics committee with input from providers, manufacturers, peer-reviewed literature, standard compendia, and other experts.

How to get prior authorization for your prescription

In order for you to receive coverage for a medication requiring prior authorization, follow these steps:

  1. Use the Medicare Drug List or Employer Drug List to determine if your prescription drug requires prior authorization for coverage.
  2. If it is required, ask your doctor to submit the request. Your doctor can submit the request online, by fax, or by phone by accessing our Provider's Prior Authorization information.
  3. Once your request has been processed, your doctor will be notified. If you are a Medicare member, you will also receive a determination letter in the mail.