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Prior authorization submission information

Professionally administered drugs prior authorization

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Prior authorization for professionally administered drugs 

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Prior authorization for pharmacy drugs

Confirming prior authorization requirements

Search by CPT code, procedure or drug name to see if prior authorization is required. 

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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.

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

Puerto Rico prior authorization

For pharmacy drugs, prescribers can submit their requests to Humana Clinical Pharmacy Review (HCPR) — Puerto Rico through the following methods:

Phone requests: 1-866-488-5991

Hours: 8 a.m. to 6 p.m. local time, Monday through Friday

Fax requests: Complete the applicable form below and fax it to 1-855-681-8650. To submit a request for a professionally administered drug, see the information at the bottom of this Web page.

Puerto Rico 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, precertification and claims. It also provides applicable phone, fax and Web contact information.

Forms for state mandates

Universal form for state mandates

The use of this form is mandated for prior authorization requests concerning commercial fully insured members:

Who reside in Arkansas, Mississippi or Oklahoma and/or

Whose prescription drug coverage was sold in a state listed above

State-specific prior authorization request form

Arizona authorization form

The use of this form is mandated for prior authorization requests concerning commercial fully insured members:

Who reside in the state of Arizona, and/or

Whose prescription drug coverage was sold in the state of Arizona

Arizona prior authorization request form

California authorization form

The use of this form is mandated for prior authorization requests concerning commercial fully insured members:

Who reside in the state of California, and/or

Whose prescription drug coverage was sold in the state of California

Prescription drug prior authorization request form

Colorado authorization forms

The use of these forms are mandated for prior authorization requests concerning commercial fully insured members:

Who reside in the state of Colorado and/or

Whose prescription drug coverage was sold in the state of Colorado

Uniform pharmacy prior authorization request form

Alternative Contraceptive authorization exemption form

Illinois authorization request form

Physicians and healthcare practitioners in Illinois should use this form to submit authorization requests for their Humana commercial fully insured covered patients and residents. Please complete the form and submit it to Humana by following the instructions on the form.

Illinois authorization request form

Kentucky Medicaid Authorization Form

Physicians and health care practitioners in Kentucky may use this form to submit authorization requests for their Humana-Medicaid covered patients. Please complete the form and submit it to Humana by following the instructions on the form.

Prescription drug prior authorization request form

Louisiana authorization form

The use of this form is mandated for prior authorization requests concerning commercial fully insured members:

Who reside in the state of Louisiana and/or

Whose prescription drug coverage was sold in the state of Louisiana

Louisiana uniform prescription drug prior authorization form

New Mexico authorization request form

Physicians and health care practitioners may use this form to submit authorization requests for their New Mexico Humana-Covered patients. Please complete the form and submit it to Humana by following the instructions on the form.

New Mexico authorization request form

Texas authorization form

Physicians and health care practitioners in Texas may use this form to submit authorization requests for their Humana-covered patients. Please complete the form and submit it to Humana by following the instructions on the form.

Texas authorization request form

Texas Prior Authorization Exemption information:

Texas House Bill 3459 - Preauthorization Exemption FAQ

To designate your preferred contact and delivery information for communications, please refer to the "Address Change or Other Practice Information" section of the Humana Provider Manual at Humana.com/ProviderManual.

Questions on state-mandated forms

If you have questions about whether you should use the state-mandated forms above, please call HCPR at 1-800-555-CLIN (2546).

Medicare coverage determination form

Request for coverage determination (also known as prior authorization form)

Request for coverage determination – English

Request for coverage determination – Spanish

For Puerto Rico

Request for coverage determination – English

Request for coverage determination – Spanish

If you prefer, you may complete the Coverage Determination Request Form online.

Another option is to use the Centers for Medicare & Medicaid Services (CMS) Coverage Determination Request Form.

Please note the following regarding medically accepted indications:

All reasonable efforts have been made to ensure consideration of medically accepted indications in Humana’s prior authorization policies. Medically accepted indications are defined by CMS as those uses of a covered Part D drug that are approved under the Federal Food, Drug, and Cosmetic Act or the use of which is supported by one or more citations included or approved for inclusion in any of the compendia described in section 1927(g)(1)(B)(i) of the act. These compendia guide reviews of off-label and off-evidence prescribing and are subject to minimum evidence standards for each compendium. Currently, this review includes the following references when applicable and may be subject to change per CMS:

American Hospital Formulary Service (AHFS) Compendium

Thomson Micromedex/DrugDex (not Drug Points) Compendium

National Comprehensive Cancer Network (NCCN) Drugs and Biologics Compendium

Elsevier Gold Standard’s Clinical Pharmacology Compendium

Notice of Changes to Prior Authorization Requirements

Certain states require Humana to communicate prior authorization modifications before the effective date. The following document outlines the drugs affected by prior authorization modifications. Please reference the following document for more details:

Prior Authorization Modifications

For additional information about current prior authorizations policies, please reference Medical and Pharmacy Coverage Policies page.

Prior authorizations for professionally administered drugs

Pharmacy resources