Provider Authorisation

Prior authorization for pharmacy drugs

A request must be submitted and approved in advance for medications requiring a prior authorization, before the drugs may be covered by Humana.

Submitting a request for a prescription drug prior authorization

Prescribers can submit their requests to Humana Clinical Pharmacy Review (HCPR):

Electronic requests: CoverMyMeds® is a free service that allows prescribers to submit and check the status of prior authorization requests electronically for any Humana plan. You can access this service directly (registration required) or review the flyer below for details.

Visit CoverMyMeds

CoverMyMeds overview flyer

Phone requests: Call 1-800-555-CLIN (2546) between 8 a.m. and 6 p.m. local time, Monday through Friday.

Fax requests: Complete the applicable form and fax it to 1-877-486-2621.

Puerto Rico requests

Requests for Puerto Rico members can be submitted via the following methods:

Phone: 1-866-488-5991

Fax: 1-855-681-8650

Prescriber quick reference guide

This guide helps prescribers determine which Humana medication resource to contact for prior authorization, step therapy, quantity limits, medication exceptions, appeals and claims. It also provides applicable phone, fax and Web contact information.

Forms for state mandates

Universal form for state mandates

The use of this form is mandated for prior authorization requests concerning commercial fully insured members…

  • Who reside in Arkansas, Louisiana, Mississippi or Oklahoma, and/or
  • Whose prescription drug coverage was sold in a state listed above.

State-specific prior authorization request form

California authorization form

The use of this form is mandated for prior authorization requests concerning commercial fully insured members…

  • Who reside in the state of California, and/or
  • Whose prescription drug coverage was sold in the state of California.

Prescription drug prior authorization request form

Colorado authorization form

The use of this form is mandated for prior authorization requests concerning commercial fully insured members…

  • Who reside in the state of Colorado, and/or
  • Whose prescription drug coverage was sold in the state of Colorado.

Prescription drug prior authorization request form

Texas authorization form

Physicians and health care practitioners in Texas may use this form to submit authorization requests for their Humana-covered patients. Please complete the form and submit it to Humana by following the instructions on the form.

Texas authorization request form

If you have questions about whether you should use the state-mandated forms above, please call HCPR at 1-800-555-CLIN (2546).

Medicare coverage determination form

Request for coverage determination (also known as prior authorization form)

Request for coverage determination - English (0.5 MB)

Request for coverage determination - Spanish (0.5 MB)

If you prefer, you may complete the coverage determination request form online. Before completing the form, you may want to view our accepted file types.

Another option is to use the CMS coverage determination request form.

Please note the following regarding medically accepted indications:

All reasonable efforts have been made to ensure consideration of medically accepted indications in Humana's prior authorization policies. Medically accepted indications are defined by the Centers for Medicare & Medicaid Services (CMS) as those uses of a covered Part D drug that are approved under the Federal Food, Drug and Cosmetic Act or the use of which is supported by one or more citations included or approved for inclusion in any of the compendia described in section 1927(g)(1)(B)(i) of the act. These compendia guide reviews of off-label and off-evidence prescribing and are subject to minimum evidence standards for each compendium. Currently, this review includes the following references when applicable and may be subject to change per CMS:

  • American Hospital Formulary Service (AHFS) Compendium
  • Thomson Micromedex/DrugDex (not Drug Points) Compendium
  • National Comprehensive Cancer Network (NCCN) Drugs and Biologics Compendium
  • Elsevier Gold Standard's Clinical Pharmacology Compendium