When a prescribing physician or other prescriber disagrees with the outcome of the initial coverage determination or exception request, he or she may request a standard or expedited redetermination. If the prescribing physician or other prescriber making the request is not acting as the patient’s representative, notice of the request must be given to the patient before the request is made. A patient or the patient’s representative may also request a standard or expedited redetermination. Prescribers may do the following within 60 calendar days of the date of the denial notice they received from Humana (unless the filing window is extended):
Request an expedited redetermination
If you believe that waiting 7 days for a standard decision could seriously jeopardize the patient's life, health or ability to regain maximum function, you can ask for an expedited redetermination, and we will give you a decision within 72 hours. You may request an expedited decision by:
- Phone: 1-800-867-6601 (continental U.S.) or 1-866-773-5959 (Puerto Rico)
- Fax: 1-800-949-2961 (continental U.S.) or 1-800-595-0462 (Puerto Rico)
Request a standard Part D redetermination online
Follow these directions to use our online , opens new windowStandard Redetermination Form:
- Enter the prescription drug information.
- Indicate the reason you are appealing the denial.
- Provide any clinical rationale.
- Enter your information.
- Attach supporting documentation for your appeal.
If you need to fax supporting documentation, please fax the materials to 1-877-486-2621 (continental U.S.) or 1-800-595-0462 (Puerto Rico).
Once Humana receives your request, we will provide written notice of our decision within 7 calendar days.
Request a standard Part D redetermination by phone or fax
You may file a verbal standard redetermination request by calling us at 1-800-457-4708 (continental U.S.) or 1-866-773-5959 (Puerto Rico) (TTY: 711), Monday – Friday, 8 a.m. – 8 p.m., local time. Hours of operation from Oct. 15 to Feb. 14 include Saturdays and Sundays, 8 a.m. – 8 p.m.
Requests may be faxed to 1-800-949-2961 (continental U.S.) or 1-800-595-0462 (Puerto Rico).
We strongly encourage prescribers to provide additional supporting documentation for redetermination requests.
Once the request is received, Humana will provide written notice of its decision within 7 calendar days for standard requests.
Request a standard Part D redetermination by mail
You may request a redetermination by mail by submitting your request in writing to:
Continental U.S.: Humana Appeals, P.O. Box 14546, Lexington, KY 40512-4546
Puerto Rico: Humana Appeals, P.O. Box 195560, San Juan, PR 00919-5560
In the letter, include your name, address, Humana member ID number and the reason for the appeal. Please include notes or documents that support your request. We will investigate your appeal and inform you of our decision.
, opens new windowRequest for Redetermination of Medicare Prescription Drug Denial Form