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Prior authorization submission information

Professionally administered drugs prior authorization

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Prior authorization for professionally administered drugs 

Locate state-specific resources for Humana Healthy Horizons® (Medicaid).

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Humana Healthy Horizons in Virginia

Prior authorization (PA) is the process through which the PCP or other healthcare provider obtains approval from the plan as to whether an item, drug or service is covered, and is an important component to managed care.

Requests for PA should be made as soon as possible, but at least 14 days in advance of the service date. If PA is required and not obtained, it may result in a reduction or denial of payment. Services provided without PA also may be subject to retrospective review. When retrospective reviews are performed, clinical information should be included to perform a medical necessity review. A summary of why PA was not obtained should also be included in the review.

Our PA list can be found at Humana.com/PAL. Please note the PA list is subject to change. Changes to PA requirements are posted to Humana.com/PAL. a minimum of 45 days prior to the effective date of the change. Medical services and behavioral health/SUD services are evaluated for addition to or removal from the PA list, utilizing factors established in the Mental Health Parity Addiction and Equity Act of 2008.

Humana Healthy Horizons does not require referrals from primary care physicians (PCPs) to see participating specialists; however, prior authorization must be obtained to see nonparticipating providers. Members may self-refer to any participating provider.

If a member requires medically necessary services from a nonparticipating provider, the provider may call the Provider Services Contact Center to obtain prior authorization at 855-223-9868 (TTY: 711), Monday through Friday, 8 a.m. to 5 p.m. Central time to obtain prior authorization.

Submitting a request for prior authorization

A request must be submitted and approved in advance for medications requiring a prior authorization, before the drugs may be covered by Humana.

Prescribers can submit their requests to Humana Clinical Pharmacy Review (HCPR) in the following ways:

Electronic requests

CoverMyMeds® is a free service that allows prescribers to submit and check the status of prior authorization requests electronically for any Humana plan. You can access this service directly (registration required) or review the flyer below for details.

Visit CoverMyMeds

CoverMyMeds overview flyer

Phone requests

Call 1-800-555-CLIN (2546), Monday – Friday, 8 a.m. – 8 p.m., local time.

Phone user guide

Fax requests

Complete the applicable form and fax it to 1-877-486-2621.

Service authorization request forms

Antipsychotics in children younger than 18 years old

GLP-1 receptor agonists for cardiovascular risk reduction

GLP-1 receptor agonists for  obstructive sleep apnea

Short and long-acting opioid request form

Weight-loss management

Virginia Medicaid professionally-administered drug precertification request form

Virginia Medicaid pharmacy precertification request form

Prescriber quick reference guide: This guide helps prescribers determine which Humana medication resource to contact for prior authorization, step therapy, quantity limits, medication exceptions, appeals and claims. It also provides applicable phone, fax and web contact information.

Prescriber quick reference guide

Contact information for prior authorization

PA assistance for medical procedures and behavioral health: 855-223-9868

PA assistance for pharmacy: 800-555-2546

Availity portal



Prior Authorization

Virginia Medicaid