Humana strives to make the prescription process as easy as possible for physicians and health care professionals and their patients. 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 process, fax completed prior authorization prescription request forms to Humana at 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:
Also, please note that some requests for authorization require appropriate lab information before they can be processed
Health care professionals 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: http://www.humana.com/providers/pharmacy/drug_list.aspx.
HCPR can be contacted with questions by calling 1-800-555-CLIN (2546), Monday through Friday, 8 a.m. to 8 p.m. local time.
Prior authorization target turnaround time
Prescribers have two turnaround options when submitting requests for coverage determination.
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 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 quantity requests.
Step therapy authorization requests
Step therapy protocols require patients with Humana coverage to use preferred medications before using medications considered to be second-line or third-line. These protocols comply with 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. Restrictions are 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: http://www.humana.com/providers/tools/prescription_tools/exceptions_appeals.asp.
HCPR can be contacted with questions at 1-800-555-CLIN (2546), Monday through Friday, 8 a.m. to 8 p.m. local time.