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Humana Healthy Horizons in Virginia

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Humana Healthy Horizons in Virginia covers a wide range of prescription and over the counter medications to help keep our members healthy. Learn about Humana Healthy Horizons pharmacy benefits, and what we cover for our members.

Covered Medications

Prescription medications

We strive to keep prescription drug costs low for our members. We cover the prescription medications on the preferred drug list, or formulary. Drugs on the formulary are offered at no cost to Virginia Cardinal Care members. You can download the preferred drug list to see up late updates. If a medically necessary medication isn't on the formulary, you can prescribe a similar one that is on the list or get prior authorization for coverage.

Preferred Drug List – English

Preferred Drug List – Spanish

Preferred Drug List - Machine Readable

Summary of drug list changes – English

Summary of drug list changes – Spanish

Generic drugs

Where available, generic drugs should be prescribed to Humana Healthy Horizons in Virginia members. Generic alternatives and equivalents to brand-name medications may help patients save money. The U.S. Food and Drug Administration (FDA) states that it ensures the safety and effectiveness of the generic drugs it approves. A generic equivalent is identical, or bioequivalent, to a brand-name drug and must have the same active ingredient, strength, dosage form and route of administration as the brand-name product.

A generic alternative is not a direct generic for a particular branded medication, but in most cases it is in the same therapeutic class as the brand. Alternative drugs produce similar clinical outcomes and often have similar side-effect profiles.

You can download a guide to generic equivalents and alternatives:

Humana generic drug guide

Specialty medications

If you prescribe a specialty medication for a complex or long-lasting condition, members can fill it at any pharmacy in our network. Not all pharmacies carry these medications, so members may need to find a specialty pharmacy. Humana invites members to fill specialty prescriptions at CenterWell Specialty Pharmacy. CenterWell will conveniently fill and mail prescriptions directly to the patient’s home. For more information, call: CenterWell Specialty Pharmacy Call 844-486-2668 (TTY: 711), Monday – Friday, 8 a.m. – 11 p.m., and Saturday, 8 a.m. to 6:30 p.m., Eastern time

Over-the-counter medications

Virginia Cardinal Care covers some over-the-counter (OTC) drugs. Members can get coverage for OTC drugs when they:

Get a prescription from their provider

Fill their OTC prescription at a pharmacy in our network

Present the prescription at the pharmacy.

You can view a list of OTC medications that are covered as a part of the Humana Healthy Horizons pharmacy benefit in the Preferred Drug List (PDL)

Medication Therapy Management

For members enrolled in eligible Medicare or Medicaid plans, Humana offers a Medication Therapy Management (MTM) program that helps ensure patients achieve the best possible outcomes from their medications. The patient-centered MTM program promotes collaboration between the pharmacist, patient and prescriber to optimize safe and effective medication use. The goal of this program is to optimize therapeutic outcomes by focusing on safety, effectiveness, lower-cost alternatives and adherence.

For more information on Humana’s Medication Therapy Management program and how you can get involved to ensure the best possible outcomes for patients, visit this link: Humana Medication Therapy Management program.

Virginia Medicaid

Other Resources

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