2019 formulary changes

"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."

Medicare formulary changes High-risk medication updates Medications seniors should avoid

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.

Medications seniors should avoid , PDF opens new window

Drug guides

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

Prescriber quick reference guide

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.

Prescriber quick reference guide , PDF opens new window

State specific formulary plans

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.

State Formulary program

Florida

Florida Managed Medical Assistance (MMA) Program (Humana Medical Plan) formulary

Humana medical plan formulary – English , PDF opens new window

Humana medical plan formulary – Spanish , PDF opens new window

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.

Florida Medicaid Preferred Drug List , opens new window

Illinois

Humana Gold Plus Integrated (Illinois Medicare-Medicaid)

Illinois Medicare-Medicaid – English , PDF opens new window

Illinois Medicare-Medicaid – Spanish , PDF opens new window

Humana Drug List

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.