Humana pharmacists review and update the Drug List annually to help ensure members' safety and to provide cost-effective choices. A yearly review happens because prescribing guidelines are adjusted for medicines or supplies, new drugs become available or some are removed.
- Level changes: Covered medicines are grouped in different levels. If you fill or refill a prescription for a medicine or supply that’s moving to a higher level, you may have to pay more. If you fill or refill a prescription for a medicine or supply that’s moving to a lower level, you may pay less.
- Prior authorization: Your doctor will need to contact Humana to provide prior approval for your medicine before it’s covered. You can also talk to your doctor about other medications that are covered under your plan that could work for you.
- Step therapy: Some medicines have a step therapy requirement. This means you need to try at least one lower cost option before the medicine is covered. Work with your doctor to determine if the lower cost option is right for you. If not, your doctor will need to request approval from Humana to cover your current medicine.
- Quantity limit: There will be a limit on the amount of some medicines you can get during a period of time. These limits can be placed on some medicines because of safety concerns and to help prevent misuse. The limits are based on approved product information from the Food and Drug Administration and manufacturer recommendations.
- Not covered: The medicines listed on your plan’s Drug List, or formulary, change every year. If your medicine or supply is no longer on the Drug List, you’ll have to pay the full cost. Your doctor can ask Humana to cover your medicine or supply if he or she believes the alternative is not right for you.
How to keep medication costs affordable
You have several options to help control medication costs. Talk to your doctor about possible lower cost alternatives, which include:
- Using generic medications. Read more about generics vs. brand-name medications.
- Using a mail-delivery pharmacy like Humana Pharmacy to obtain a 90-day supply of your maintenance medications. Maintenance medications, such as those that treat high cholesterol, mental health or hypertension, are taken long term.
- Using over-the-counter (OTC) medications, if appropriate. For example, common allergy and heartburn medications have several OTC options.
- Finding out if the drug manufacturer or specialty pharmacy offers a patient assistance program that you can use.