New and Revised Pharmacy and Medical Coverage Policies Available

Humana's medical and pharmacy coverage policies are based on evidence published in peer-reviewed medical literature, technology assessments obtained from independent medical research organizations, evidence-based consensus statements and evidence-based guidelines from nationally recognized professional health care organizations.

Information about medical and pharmacy coverage policies can be found at Humana.com/provider by selecting "Medical and Pharmacy Coverage Policies" under "Resources." Policies can be reviewed by name or revision date. Users also may search for a particular policy using the search box. More detailed information can be found by reviewing "How to Read a Medical Coverage Policy" and "Understanding the Medical Coverage Policy Development Process" under “Helpful Links.”

Recent changes to medical and pharmacy coverage policies are listed below:

New pharmacy coverage policies

  • Basaglar (insulin glargine)
  • Rayaldee (calcifediol)

New medical coverage policies

  • No new policies

Revised pharmacy coverage policies

  • Clobex (clobetasol)
  • Compounded medications
  • Opdivo (nivolumab)
  • Taclonex (calcipotriene and betamethasone dipropionate)
  • Vivitrol (naltrexone for extended release injectable suspension)

Revised medical coverage policies

  • Bariatric Surgery
  • Bone Graft Substitutes
  • Cardioverter Defibrillators/Cardiac Resynchronization Therapy
  • Cardiac Monitoring Devices
  • Colorectal Cancer Screening
  • Cryoablation
  • Durable Medical Equipment (DME)
  • Electric Tumor Treatment Fields
  • Gene Expression Profiling
  • Genetic Testing for Breast and/or Ovarian Cancer Susceptibility
  • Genetic Testing for Cancer Susceptibility
  • Genetic Testing for Marfan Syndrome and Related Conditions
  • Genetic Testing for Muscular Dystrophy and Spinal Muscular Atrophy
  • Headache and Occipital Neuralgia Treatments
  • Home Oximetry Monitoring
  • Janus Kinase 2 (JAK2) V617F, Exon 12 & 13, and MPL Mutation Analysis
  • Lymphedema – Diagnosis and Treatments
  • Negative Pressure Wound Therapy (NPWT)
  • Noninvasive Tests for Hepatic Fibrosis
  • Transcatheter Valve Implantation
  • Tumor Markers for Diagnosis and Monitoring of Cancer
  • Vocal Cord Insufficiency Treatments