"Below are links to charts that show some commonly used medications impacted by Humana commercial and Medicare formulary changes in 2019 (e.g., prior authorization [PA] requirements, step therapy [ST] modifications and nonformulary [NF] changes). Humana members are asked to talk to their physician or other health care professionals about possible alternatives."
Below are links to formularies containing some commonly used medications that will be impacted by Humana Medicare formulary changes in 2019. Top drug changes by formulary include:
If healthcare providers have questions regarding these changes, they may call 1-800-457-4708. This line is open Monday through Friday from 8 a.m. to 8 p.m. local time.
According to the Centers for Medicare & Medicaid Services, some drugs should be avoided or used with caution in the senior population. These drugs are known as "high-risk medications" and are considered by medical experts to pose a safety concern due to the increased risk of harmful side effects. These side effects may include falls, confusion, drowsiness and weakness. Even if your patient is not experiencing any side effects, please continue to evaluate his or her medicines for potential side effects or issues.
View a regularly updated list adapted from the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS®) measure.
Access more formulary-related information for Humana members by reviewing Humana's list of covered drugs.
Medicare: Drug List for Medicare plans
Commercial: Drug List for employer plans
This reference 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.
Each formulary is a list of covered drugs selected by Humana in consultation with a team of healthcare practitioners. It represents the prescription therapies believed to be a necessary part of a quality treatment program.
Florida
Florida Managed Medical Assistance (MMA) Program (Humana Medical Plan) formulary
Florida’s Agency for Health Care Administration (AHCA) regularly updates the Florida Medicaid Preferred Drug List. Please see the link below for changes to the formulary for patients with Florida Medicaid coverage.
Illinois
Humana Gold Plus Integrated (Illinois Medicare-Medicaid)
Humana's lists of prescription drugs are developed and maintained by a medical committee consisting of doctors and pharmacists. Member drug coverage varies by plan. Certain drugs may have coverage limitations based on duration or dosage, or may require preapproval. Humana may add drugs to the list, change drugs on the list, or remove drugs from the list at any time, which could affect the amount the member pays for prescription drugs.