Certain prescription drugs require prior authorization (PA) or a medical exception for coverage. If a member’s drug requires this step, their doctor will need to request and receive approval from Humana before the drug may be covered under their insurance plan.
Which drugs require Prior Authorization?
Use the Drug List Search to see which prescription drugs require Prior Authorization.
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 can a member get Prior Authorization for a prescription?
In order for a member to receive coverage for a medication requiring prior authorization, their physician must submit a request and provide the appropriate clinical information. Doctors can submit the request Online, by Fax, or by Phone accessing our Provider’s Prior Authorization information.
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