For pharmacy drugs, prescribers can submit their requests to Humana Clinical Pharmacy Review (HCPR) — Puerto Rico through the following methods:Phone requests: 1-866-488-5991
Hours: 8 a.m. to 6 p.m. local time, Monday through Friday
Fax requests: Complete the applicable form below and fax it to 1-855-681-8650. To submit a request for a professionally administered drug, see the information at the bottom of this Web page.
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. Visit www.covermymeds.com to use this service (registration required) or review the flier below for details.Puerto Rico prescriber quick reference guide - English (42Kb)
This guide helps prescribers determine which Humana medication resource to contact for prior authorization, step therapy, quantity limits, medication exceptions, appeals, precertification and claims. It also provides applicable phone, fax and Web contact information.
Use this fax form to request use of medications identified by the Beer’s criteria as potentially high risk and inappropriate for use in the elderly.
Before submitting a prior authorization request for an elderly patient, please review this list of medications to avoid in the elderly. It is adapted from the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS®) measure, Use of High-Risk Medications in the Elderly.Brand-name multisource authorization (MSB) form - English (184Kb)
Use this fax form to request use of brand-name medications that have a generic equivalent available.Nonformulary drug authorization form - English (201Kb)
Use this fax form to request use of medications not on the member’s formulary.Hospice medications (129 Kb)
Use this fax form to request use of hospice medications.
If a specific fax form for the medication being requested is not located above, please use the universal fax form below.
Request for coverage determination (also known as prior authorization form)
Another option is to use the coverage determination request form on the CMS website.
Please note the following regarding medically accepted indications:
All reasonable efforts have been made to ensure consideration of medically accepted indications in this policy. 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 Social Security 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 review 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:
Some drugs require prior authorization before they can be delivered or administered in a physician's office, clinic, outpatient or home setting.
Prescribers should submit these requests to the Puerto Rico Medication Intake Team by fax at 1-800-594-5309 (Medicare requests) or 1-800-658-9457 (commercial requests).Prescribers with questions about the prior authorization process for professionally administered drugs should call
1-866-488-5995 for Medicare requests and 1-800-314-3121 for commercial requests. Assistance is available Monday through Friday, 8:30 a.m. to 5:30 p.m. local time.
To view a list of drugs for which Humana requires prior authorization, see the applicable preauthorization and notification list.