Providers should review the Humana Healthy Horizons in Indiana (PathWays) Preauthorization and Notification List online at Humana.com/PAL .

IHCP Prior Authorization Request Form

PathWays Medication Preauthorization and Notification List

Pharmacy prior authorization

The process by which medication is supplied by a pharmacy and billed through the pharmacy benefit includes medication prior authorization, quantity limits and medication exceptions. To learn more or view the full list of medications requiring prior authorization:

• Contact Us: 800-555-2546, Monday - Friday 8am -11pm ET. Please note, Urgent After-Hours Voicemail is monitored on the weekends.

Right Choices Program

• Call 833-410-2496, option 7, from 8 a.m. to 5:30 p.m., Eastern time. After hours, please leave a voicemail with the member's name, Medicaid ID number, contact phone number and a detailed description of your request.
• Fax 502-996-8184.
• Email  CPORM@humana.com .

To request prior authorization for services

Except where otherwise noted in your Provider Manual requests for services may be initiated:

• Online via  Availity Essentials . Registration is required, and online prior authorization requests are encouraged.
• By calling our authorization intake team directly at
  • 800-555-2546, Monday - Friday 8 a.m. – 8  p.m. ET
• Fax the IHCP Prior Authorization Request Form to 502-324-6376 (Medicaid only) or 502-405-5020 (dual eligible) for both physical health and behavioral health authorizations.

Peer-to-peer (P2P) consultations

Providers may request a P2P consultation when Humana Healthy Horizons denies a prior authorization request. If you would like to request a P2P discussion on a determination with a Humana Healthy Horizons provider reviewer:

• email to  INMCDP2PRequest@humana.com
• fax your request to 502-324-6376
• or by calling our authorization intake team directly at 800-555-2546, Monday – Friday, 8 a.m. – 8 p.m. ET

The P2P request must be made within 15 business days of the determination.

Statewide Uniform Preferred Drug List (SUPDL)

Indiana SUPDL

Prior Authorization Request Forms

Antiviral Monoclonal Antibodies Form

Benzo-Opioid Duplicate Therapy PA Form

Bone Formation Stimulating Agents PA Form

Buprenorphine-Opioid Concurrent PA Form

Cardiac Agents PA Form

Carisoprodol PA Form

Dificid PA Form

Growth Hormone Adult PA Form

Growth Hormone Children PA Form

Hetlioz PA Form

Narcolepsy Agents PA Form

Opioid MME Limit Exceed PA Form

PCSK9 and Select Lipotropics PA Form

Pulmonary Antihypertensives PA Form

Testosterones PA Form

Uterine Disorder Agents PA Form

Vaginal Antimicrobials PA Form