Pharmacy Authorizations

Document created by humanaadmin3 Moderator on Aug 3, 2018Last modified by communitymanager on Oct 23, 2019
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Prior Authorizations

Certain prescription drugs require prior authorization (PA) or a medical exception for coverage. If your drug requires this step, your doctor will need to request and receive approval from Humana before the drug may be covered under your insurance plan.


Why is Prior Authorization required?

To promote the most appropriate drug utilization, selected high risk or high cost medications require prior authorization by the Humana Clinical Pharmacy Review (HCPR) to be eligible for coverage. Prior Authorization criteria are established by Humana's Pharmacy and Therapeutics committee with input from providers, manufacturers, peer-reviewed literature, standard compendia, and other experts.



How to get Prior Authorization for your prescription

In order for you to receive coverage for a medication requiring prior authorization, follow these steps:

  1. Use the Drug List Search to determine if your prescription drug requires Prior Authorization for coverage.
    You can also find the Drug List on your MyHumana mobile app using the Drug Pricing Tool on the dashboard.
  2. If a PA is required, ask your doctor to submit the request. Your doctor can submit the request , by fax, or by phone by accessing our Provider's Prior Authorization information.
  3. Once your request has been processed, your doctor will be notified. If you are a Medicare member, you will also receive a determination letter in the mail.