Submitting a request for prior authorization

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

Prescribers can submit their requests to Humana Clinical Pharmacy Review (HCPR) in the following ways:

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, opens new window

CoverMyMeds overview flyer, PDF opens new window

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

Phone user guide, PDF opens new window

Fax requests: Complete the applicable form and fax it to 1-877-485-2621.

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.

Prescriber quick reference guide, PDF opens new window

Puerto Rico prior authorization

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.

Puerto Rico Prescriber quick reference guide, PDF opens new window

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.

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, Mississippi or Oklahoma and/or
  • Whose prescription drug coverage was sold in a state listed above

State-specific prior authorization request form, PDF opens new window

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, PDF opens new window

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

Uniform pharmacy prior authorization request form, PDF opens new window

Louisiana authorization form

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

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

Louisiana uniform prescription drug prior authorization form, PDF opens new window

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, PDF opens new window

Questions on state-mandated forms

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, PDF opens new window

Request for coverage determination – Spanish, PDF opens new window

For Puerto Rico

Request for coverage determination – English, PDF opens new window

Request for coverage determination – Spanish, PDF opens new window

If you prefer, you may complete the Coverage Determination Request Form, opens new window online. Before completing the form, you may want to view our accepted file types, opens new window.

Another option is to use the Centers for Medicare & Medicaid Services (CMS) Coverage Determination Request Form, opens new window.

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 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