Physicians Encouraged to Review Updates on Prior Authorization, Quantity Limits and Step Therapy

Prescription process

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:

  • Prior authorizations
  • Quantity limits exception requests
  • Step therapy authorizations
  • Other medication exception requests

Prior authorizations

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:

  • 1. Visit Humana's website.
  • 2. Utilize Humana's self-service interactive voice response system to request fax forms by calling 1-800-555-CLIN (2546).

When completing a prior authorization request, the following information is needed:

Patient information

  • Member ID
  • Patient demographic information
  • Drug, strength, dosage
  • Patient diagnosis
  • Drug allergies or medical conditions
  • Other therapies attempted
  • Desired length of therapy
  • Medical records, only for medical necessity or off-label use review (not for every submission)
  • Some requests for authorization require appropriate lab information before they can be processed

Prescriber information

  • Tax identification number
  • Prescriber demographic information

Health care providers who want to submit a pharmacy authorization request to Humana Clinical Pharmacy review (HCPR) online can use the following methods:

  • Cover MyMeds® – This free service allows prescribers to submit and check the status of prior authorization requests electronically for any Humana plan. Visit for more information.
  • Availity Web Portal – Health care providers need to be registered to use Availity. To register, go to and select “GET STARTED” to sign up. Once logged in, select “Payer Spaces,” then “Humana,” then “Pharmacy Prior Authorization.”

A list of drugs that require prior authorization is available online at:

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.

Prior authorization target turnaround time

Prescribers have two time options when they submit requests.

  • Standard HCPR requests will give prescribers a decision within 72 hours of Humana’s receipt of supporting documentation for authorization.
  • An expedited review can be requested if the standard response time would cause serious harm or endanger a member's health. Expedited HCPR requests for Medicare members will be reviewed, and prescribers will receive a decision within 24 hours of receiving their supporting statement for authorization.

Quantity limit exception 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 authorization requests

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 medication exception requests

Other requests include tiering exceptions, formulary exceptions (both nonformulary drugs and formulary drugs with a utilization management requirement) and hospice.

Exceptions and appeals

Information about exceptions and appeals is available online at:

HCPR can be contacted with questions at 1-800-555-CLIN (2546), Monday through Friday, 8 a.m. to 6 p.m. local time.