Prior authorization for professionally administered drugs

Submitting a prior authorization request

Prescribers should complete the applicable form below and fax it to Humana’s medication intake team (MIT) at 1-888-447-3430. To obtain the status of a request or for general information, you may contact the MIT by calling 1-866-461-7273, Monday – Friday, 8 a.m. – 6 p.m., Eastern time.

Puerto Rico prior authorization requests

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.

Forms for state mandates

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, PDF opens new window

Texas authorization form

Physicians and healthcare 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

If you have questions about whether you should use the state-mandated form(s) above, please call the MIT at 1-866-461-7273, Monday – Friday, 8 a.m. – 6 p.m., Eastern time.

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, prior authorization and claims. It also provides phone, fax and web contact information.

Prescriber quick reference guide, PDF opens new window

Fax forms

A–F G-N O-Z AHCA Florida Medicaid

Abraxane – Medicare ONLY, PDF opens new window

Abraxane – non-Medicare, PDF opens new window

Actemra IV – Medicare ONLY, PDF opens new window

Actemra IV – non-Medicare, PDF opens new window

Acthar Gel, PDF opens new window

Adcetris, PDF opens new window

Akynzeo IV, PDF opens new window

Aldurazyme – Medicare ONLY, PDF opens new window

Aldurazyme – non-Medicare, PDF opens new window

Alimta, PDF opens new window

Aliqopa, PDF opens new window

Aloxi IV injection, PDF opens new window

Alphanate – Medicare ONLY, PDF opens new window

Alphanate – non-Medicare, PDF opens new window

Aralast-NP – Medicare ONLY, PDF opens new window

Aralast-NP – non-Medicare, PDF opens new window

Aranesp, PDF opens new window

Arcalyst, PDF opens new window

Arzerra, PDF opens new window

Atgam, PDF opens new window

Avastin, PDF opens new window

Aveed – Medicare ONLY, PDF opens new window

Aveed – non-Medicare, PDF opens new window

Azedra, PDF opens new window

Bavencio – Medicare ONLY, PDF opens new window

Bavencio – non-Medicare, PDF opens new window

Beleodaq, PDF opens new window

Bendeka, PDF opens new window

Benlysta, PDF opens new window

Berinert – Medicare ONLY, PDF opens new window

Berinert – non-Medicare, PDF opens new window

Besponsa, PDF opens new window

Bethkis – Medicare ONLY, PDF opens new window

Blincyto, PDF opens new window

Botox, PDF opens new window

Brineura, PDF opens new window

Cerezyme – Medicare ONLY, PDF opens new window

Cerezyme – non-Medicare, PDF opens new window

Cimzia – Medicare ONLY, PDF opens new window

Cinqair, PDF opens new window

Cinryze, PDF opens new window

Cinvanti, PDF opens new window

Coagadex – Medicare ONLY, PDF opens new window

Coagadex – non-Medicare, PDF opens new window

Corifact – Medicare ONLY, PDF opens new window

Corifact – non-Medicare, PDF opens new window

Crysvita, PDF opens new window

Cyklokapron, PDF opens new window

Cyramza, PDF opens new window

CytoGam, PDF opens new window

Dacogen, PDF opens new window

Darzalex, PDF opens new window

Defitelio, PDF opens new window

Doxil, PDF opens new window

Duopa, PDF opens new window

Dupixent, PDF opens new window

Durolane, PDF opens new window

Dysport, PDF opens new window

Elaprase, PDF opens new window

Elelyso – Medicare ONLY, PDF opens new window

Elelyso – non-Medicare, PDF opens new window

Elitek, PDF opens new window

Empliciti – Medicare ONLY, PDF opens new window

Empliciti – non-Medicare, PDF opens new window

Entyvio – Medicare ONLY, PDF opens new window

Entyvio – non-Medicare, PDF opens new window

Epogen – Medicare ONLY, PDF opens new window

Epogen – non-Medicare, PDF opens new window

Erbitux, PDF opens new window

Erwinaze, PDF opens new window

Eskata, PDF opens new window

Euflexxa, PDF opens new window

Evomela, PDF opens new window

Exondys 51 – Medicare ONLY, PDF opens new window

Exondys 51 – non-Medicare, PDF opens new window

Eylea – Medicare ONLY, PDF opens new window

Eylea – non-Medicare, PDF opens new window

Fabrazyme – Medicare ONLY, PDF opens new window

Fabrazyme – non-Medicare, PDF opens new window

Factor VIII Replacement Products – Medicare ONLY, PDF opens new window

Factor VIII Replacement Products – non-Medicare, PDF opens new window

Factor IX Replacement Products – Medicare ONLY, PDF opens new window

Factor IX Replacement Products – non-Medicare, PDF opens new window

Fasenra, PDF opens new window

Faslodex, PDF opens new window

FEIBA NF – Medicare ONLY, PDF opens new window

FEIBA NF – non-Medicare, PDF opens new window

Firazyr – Medicare ONLY, PDF opens new window

Firazyr – non-Medicare, PDF opens new window

Flolan, PDF opens new window

Folotyn, PDF opens new window

Fulphila, PDF opens new window

Fusilev – Medicare ONLY, PDF opens new window

Fusilev – non-Medicare, PDF opens new window

Gattex, PDF opens new window

Gazyva, PDF opens new window

Gel-One, PDF opens new window

Gelsyn-3, PDF opens new window

GenVisc, PDF opens new window

Glassia – Medicare ONLY, PDF opens new window

Glassia – non-Medicare, PDF opens new window

Granix – Medicare ONLY, PDF opens new window

Granix – non-Medicare, PDF opens new window

Growth Hormone, PDF opens new window

Haegarda, PDF opens new window

Hemlibra – Medicare ONLY, PDF opens new window

Hemlibra – non-Medicare, PDF opens new window

Herceptin, PDF opens new window

Humate-P – Medicare ONLY, PDF opens new window

Humate-P – non-Medicare, PDF opens new window

Hyalgan, PDF opens new window

Hymovis, PDF opens new window

Hypomethylating Agents (azacitidine, decitabine), PDF opens new window

Ilaris, PDF opens new window

Iluvien, PDF opens new window

Imfinzi, PDF opens new window

Imlygic, PDF opens new window

Immune Globulin – Medicare ONLY, PDF opens new window

Immune Globulin – non-Medicare, PDF opens new window

Inflectra – Medicare ONLY, PDF opens new window

Inflectra – non-Medicare, PDF opens new window

Istodax, PDF opens new window

Ixempra, PDF opens new window

Jevtana, PDF opens new window

Kadcyla, PDF opens new window

Kalbitor – Medicare ONLY, PDF opens new window

Kalbitor – non-Medicare, PDF opens new window

Kanuma – Medicare ONLY, PDF opens new window

Kanuma – non-Medicare, PDF opens new window

Keytruda, PDF opens new window

Kineret, PDF opens new window

Kitabis – Medicare ONLY, PDF opens new window

Kitabis – non-Medicare, PDF opens new window

Krystexxa – Medicare ONLY, PDF opens new window

Krystexxa – non-Medicare, PDF opens new window

Kynamro – Medicare ONLY, PDF opens new window

Kynamro – non-Medicare, PDF opens new window

Kyprolis, PDF opens new window

Lartruvo, PDF opens new window

Lemtrada, PDF opens new window

Leukine, PDF opens new window

Lucentis – Medicare ONLY, PDF opens new window

Lucentis – non-Medicare, PDF opens new window

Lumizyme – Medicare ONLY, PDF opens new window

Lumizyme – non-Medicare, PDF opens new window

Lumoxiti, PDF opens new window

Lutathera, PDF opens new window

Luxturna, PDF opens new window

Macrilen, PDF opens new window

Macugen, PDF opens new window

Makena, PDF opens new window

Marqibo, PDF opens new window

Mepsevii, PDF opens new window

Mircera, PDF opens new window

Monovisc, PDF opens new window

Mozobil, PDF opens new window

Mylotarg, PDF opens new window

Myobloc, PDF opens new window

Myozyme, PDF opens new window

Naglazyme, PDF opens new window

Neulasta, PDF opens new window

Neupogen, PDF opens new window

Nivestym, PDF opens new window

NovoSeven RT – Medicare ONLY, PDF opens new window

NovoSeven RT – non-Medicare, PDF opens new window

Nplate, PDF opens new window

Nucala, PDF opens new window

Nulojix, PDF opens new window

Obizur – Medicare ONLY, PDF opens new window

Obizur – non-Medicare, PDF opens new window

Ocrevus – Medicare ONLY, PDF opens new window

Ocrevus – non-Medicare, PDF opens new window

Oncaspar, PDF opens new window

Onivyde, PDF opens new window

Onpattro, PDF opens new window

Opdivo, PDF opens new window

Orencia IV – Medicare ONLY, PDF opens new window

Orencia IV – non-Medicare, PDF opens new window

Orthovisc, PDF opens new window

Ozurdex, PDF opens new window

Palynziq, PDF opens new window

Parsabiv, PDF opens new window

Perjeta, PDF opens new window

Portrazza – Medicare ONLY, PDF opens new window

Portrazza – non-Medicare, PDF opens new window

Poteligeo, PDF opens new window

Prevymis, PDF opens new window

Prialt, PDF opens new window

Probuphine, PDF opens new window

Procrit – Medicare ONLY, PDF opens new window

Procrit – non-Medicare, PDF opens new window

Prolastin-C – Medicare ONLY, PDF opens new window

Prolastin-C – non-Medicare, PDF opens new window

Prolia – non-Medicare, PDF opens new window

Provenge, PDF opens new window

Qutenza, PDF opens new window

Radicava – Medicare ONLY, PDF opens new window

Radicava – non-Medicare, PDF opens new window

Remicade – Medicare ONLY, PDF opens new window

Remicade – non-Medicare, PDF opens new window

Remodulin, PDF opens new window

Renflexis – Medicare ONLY, PDF opens new window

Renflexis – non-Medicare, PDF opens new window

Retacrit – Medicare ONLY, PDF opens new window

Retacrit – non-Medicare, PDF opens new window

Retisert, PDF opens new window

Revatio, PDF opens new window

Rituxan, PDF opens new window

Rituxan Hycela, PDF opens new window

Ruconest, PDF opens new window

Sandostatin LAR, PDF opens new window

Signifor LAR, PDF opens new window

Simponi Aria – non-Medicare, PDF opens new window

Sinuva, PDF opens new window

Soliris – Medicare ONLY, PDF opens new window

Soliris – non-Medicare, PDF opens new window

Somatuline Depot, PDF opens new window

Spinraza, PDF opens new window

Stelara, PDF opens new window

Strensiq, PDF opens new window

Sublocade, PDF opens new window

Supartz, PDF opens new window

Supartz FX, PDF opens new window

Sustol, PDF opens new window

Sylatron, PDF opens new window

Sylvant, PDF opens new window

Synagis, PDF opens new window

Synribo, PDF opens new window

Synvisc, PDF opens new window

Synvisc-One, PDF opens new window

Takhzyro, PDF opens new window

Tecentriq, PDF opens new window

Testopel, PDF opens new window

Thrombate III – Medicare ONLY, PDF opens new window

Thrombate III – non-Medicare, PDF opens new window

Tobi – Medicare ONLY, PDF opens new window

Tobi – non-Medicare, PDF opens new window

Treanda, PDF opens new window

Tretten – Medicare ONLY, PDF opens new window

Tretten – non-Medicare, PDF opens new window

Triptodur, PDF opens new window

Trisenox, PDF opens new window

Trogarzo – non-Medicare, PDF opens new window

Tysabri, PDF opens new window

Tyvaso, PDF opens new window

Unituxin, PDF opens new window

Valstar, PDF opens new window

Varizig, PDF opens new window

Varubi (rolapitant) IV, PDF opens new window

Vectibix, PDF opens new window

Velcade, PDF opens new window

Veletri, PDF opens new window

Ventavis, PDF opens new window

Vidaza (injection), PDF opens new window

Vimizim – Medicare ONLY, PDF opens new window

Vimizim – non-Medicare, PDF opens new window

Visco-3, PDF opens new window

Visudyne, PDF opens new window

Vonvendi – Medicare ONLY, PDF opens new window

Vonvendi – non-Medicare, PDF opens new window

VPRIV – Medicare ONLY, PDF opens new window

VPRIV – non-Medicare, PDF opens new window

Vyxeos, PDF opens new window

Wilate – non-Medicare, PDF opens new window

Wilate – Medicare ONLY, PDF opens new window

Xeomin, PDF opens new window

Xgeva, PDF opens new window

Xofigo, PDF opens new window

Xolair, PDF opens new window

Yervoy, PDF opens new window

Yondelis, PDF opens new window

Yutiq – Medicare ONLY, PDF opens new window

Yupelri, PDF opens new window

Zaltrap, PDF opens new window

Zarxio, PDF opens new window

Zavesca – Medicare ONLY, PDF opens new window

Zavesca – non-Medicare, PDF opens new window

Zemaira – Medicare ONLY, PDF opens new window

Zemaira – non-Medicare, PDF opens new window

Zevalin, PDF opens new window

Zilretta – Medicare ONLY, PDF opens new window

Zilretta – non-Medicare, PDF opens new window

Zinplava, PDF opens new window

Zoladex, PDF opens new window