Humana strives to make the prescription process as easy as possible for physicians, other health care professionals and members. Some prescriptions, however, require more attention than others.
The Humana Clinical Pharmacy Review (HCPR) team handles requests regarding:
Some drugs must undergo a criteria-based approval process prior to a coverage decision. To streamline this drug prior authorization process, requests can be faxed to Humana. Completed prior authorization prescription request forms should be faxed to 1-877-486-2621.
Prior authorization request forms may be obtained in one of two ways:
When completing a prior authorization request, the following information is needed:
Health care providers who want to submit a pharmacy authorization request to Humana Clinical Pharmacy review (HCPR) online can use the following methods:
A list of drugs that require prior authorization is available online at: https://www.humana.com/provider/medical-providers/pharmacy/tools/druglist.
HCPR can be contacted with questions by calling 1-800-555-CLIN (2546), Monday through Friday, 8 a.m. to 6 p.m. local time.
Prescribers have two time options when they submit requests.
Quantity limits are based on product information approved by the United States Food and Drug Administration and recommendations from the drug's manufacturer. These limits are reviewed and approved by Humana's Pharmacy and Therapeutics Committee, which is composed of both pharmacists and physicians.
If a patient's medication warrants additional quantities, fax a completed prior authorization prescription request to HCPR at 1-877-486-2621. The same information needed for a prior authorization request (see list above) is required for additional quantities.
Step therapy protocols require Humana members to use preferred medications before using medications considered to be second-line or third-line. These protocols are used to promote established national treatment guidelines. Additionally, step therapy protocols assist in promoting safe and cost-effective medication therapy.
Some drugs are restricted to a particular gender and/or age group for coverage. This is based on how the drug is to be used and the subpopulation the drug is intended to treat.
For an exception to a step therapy drug, fax the request to HCPR at 1-877-486-2621.
Other requests include tiering exceptions, formulary exceptions (both nonformulary drugs and formulary drugs with a utilization management requirement) and hospice.
Information about exceptions and appeals is available online at: https://www.humana.com/provider/medical-providers/pharmacy/exceptions.
HCPR can be contacted with questions at 1-800-555-CLIN (2546), Monday through Friday, 8 a.m. to 6 p.m. local time.