Coverage Determination

Some medications require approval in advance

Before filling a prescription for some medications, you may have to get approval from Humana to make sure the medication is covered under your plan. This is called “prior authorization.”

If you require prior authorization and you do not get approval from Humana before you fill the prescription, you could be responsible for all charges associated with the medication.

It’s important to have the right treatment

Here’s an example of prior authorization: you have diabetes and your doctor wants you to try a new medicine. Humana may need to pre-approve before you fill the prescription.

You may be able to appeal Humana’s decision if your medication is not authorized. You can get the forms you need by contacting us directly or through your doctor. Medicare patients can use the Medicare Part D Coverage Redetermination Request form for their appeal.

Getting your medications approved

To see if any of your drugs need to be pre-approved, you can:

You can get your doctor involved

If you learn that you need prior authorization for a prescription, your doctor will contact Humana Clinical Pharmacy Review (HCPR). Here are contacts your doctor can use:

  • Call 1-800-555-CLIN (2546):Hours are 8 a.m. to 6 p.m., local time, Monday through Friday.
  • Use fax or mail:Your doctor can visit our provider prior authorization page and complete the appropriate form. A statement of medical necessity may also be needed, possibly including specific patient medical information as well as 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.

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Already a Humana member?

Register with MyHumana to print ID cards, check claims, and get information you need anytime.

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assistance contact

Drug Pricing

Log in to MyHumana to find out if your plan covers a certain prescription drug and view estimated prices, based on the pharmacy you select.

Drug Pricing Tool (link opens in new window) 
Appointment of Representative

Appointment of Representative Form

To consider a Part D coverage determination or redetermination request from someone other than the member, we must have authorization.

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