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Pharmacy clinical coverage policies adopted by Humana Healthy Horizons in Ohio

Clinical coverage policies are resources for physicians and other Humana-contracted healthcare professionals providing care to our members enrolled in Humana Healthy Horizons® in Ohio. Humana Healthy Horizons in Ohio has adopted the following pharmacy clinical coverage policies:

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  • When filing electronic Medicaid claims, please use Payer ID 61103 for your patients with coverage through Humana Healthy Horizons in Ohio. Please do not use Humana’s traditional Payer ID for fee-for-service claims (61101) when submitting Humana Healthy Horizons in Ohio Medicaid claims. Learn more about filing electronic claims, PDF.

HU_CCP_Abraxane (nab-paclitaxel)_12-09-2022, PDF

HU_CCP_Aduhelm (aducanumab)_12-09-2022, PDF

HU_CCP_Aloxi (palonosetron)_12-09-2022, PDF

HU_CCP_Alpha-1 Proteinase Inhibitors (Aralast NP, Glassia)_12-09-2022, PDF

HU_CCP_Alpha-1 Proteinase Inhibitors (Prolastin-C, Zemaira)_12-09-2022, PDF

HU_CCP_Amvuttra (vutrisiran)_12-09-2022, PDF

HU_CCP_Avsola (infliximab-axxq)_12-09-2022, PDF

HU_CCP_Beovu (brolucizumab)_12-09-2022, PDF

HU_CCP_Bevacizumab products_12-09-2022, PDF

HU_CCP_Bortezomib products (Velcade and Bortezomib for injection)_Coversheet_12-09-2022, PDF

HU_CCP_Byooviz (ranibizumab-nuna)_12-09-2022, PDF

HU_CCP_Carvykti (ciltacabtagene autoleucel)_12-09-2022, PDF

HU_CCP_Corticotropin Products_12-09-2022, PDF

HU_CCP_Empaveli (pegcetacoplan)_12-09-2022, PDF

HU_CCP_Enjaymo (sutimlimab-jome)_12-09-2022, PDF

HU_CCP_Entyvio (vedolizumab)_12-09-2022, PDF

HU_CCP_Evomela (melphalan)_12-09-2022, PDF

HU_CCP_Firazyr (icatibant)_12-09-2022, PDF

HU_CCP_Fyarro (sirolimus protein-bound particles)_12-09-2022, PDF

HU_CCP_Hypomethylating agents_12-09-2022, PDF

HU_CCP_Inflectra (infliximab-dyyb)_12-09-2022, PDF

HU_CCP_IVIG Immune Globulin_12-09-2022, PDF

HU_CCP_Jemperli (dostarlimab-gxly)_12-09-2022, PDF

HU_CCP_Kimmtrak (tebentafusp-tebn)_12-09-2022, PDF

HU_CCP_Korsuva (difelikefalin)_12-09-2022, PDF

HU_CCP_Leqvio (inclisiran)_12-09-2022, PDF

HU_CCP_Levoleucovorin products (Fusilev, Khapzory)_12-09-2022, PDF

HU_CCP_Liposomal doxorubicin_12-09-2022, PDF

HU_CCP_Lucentis (ranibizumab)_12-09-2022, PDF

HU_CCP_Marqibo (vincristine sulfate liposome injection)_12-09-2022, PDF

HU_CCP_Nexviazyme (avalglucosidase-alfa)_12-09-2022, PDF

HU_CCP_Non-Preferred Filgrastim Products_12-09-2022, PDF

HU_CCP_Opdualag (nivolumab and relatlimab-rmbw)_12-09-2022, PDF

HU_CCP_Parsabiv (etelcalcetide)_12-09-2022, PDF

HU_CCP_Pemetrexed Products_12-09-2022, PDF

HU_CCP_Pluvicto (lutetium Lu 177 vipivotide tetraxetan)_12-09-2022, PDF

HU_CCP_Remicade (infliximab)_12-09-2022, PDF

HU_CCP_Renflexis (infliximab-abda)_12-09-2022, PDF

HU_CCP_Rituxan Hycela (rituximab-hyaluronidase)_12-09-2022, PDF

HU_CCP_Rituximab products_12-09-2022, PDF

HU_CCP_Rybrevant (amivantamab)_12-09-2022, PDF

HU_CCP_Rylaze (asparaginase Erwinia chrysanthemi recombinant-rywn)_12-09-2022, PDF

HU_CCP_Ryplazim (plasminogen, human-tvmh)_12-09-2022, PDF

HU_CCP_Saphnelo (anifrolumab-fnia)_12-09-2022, PDF

HU_CCP_Signifor LAR (pasireotide)_12-09-2022, PDF

HU_CCP_Somatuline Depot (lanreotide)_12-09-2022, PDF

HU_CCP_Sustol (granisetron)_12-09-2022, PDF

HU_CCP_Susvimo (ranibizumab)_12-09-2022, PDF

HU_CCP_Tezspire (tezepelumab-ekko)_12-09-2022, PDF

HU_CCP_Tivdak (tisotumab vedotin-tftv)_12-09-2022, PDF

HU_CCP_Vabysmo (faricimab-svoa)_12-09-2022, PDF

HU_CCP_Viscosupplements Coversheet_12-09-2022, PDF

HU_CCP_Vyondys (golodirsen) 53_12-09-2022, PDF

HU_CCP_Vyvgart (efgartigimod alfa-fcab)_12-09-2022, PDF

HU_CCP_Xipere (triamcinolone acetonide)_12-09-2022, PDF

HU_CCP_Zolgensma (onasemnogene abeparvovec-xioi)_12-09-2022, PDF

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