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.
Phone requests: Call 1-800-555-CLIN (2546), Monday – Friday, 8 a.m. – 8 p.m., local time.
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.
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.
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
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
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
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
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.
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.
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
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.
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 Prior Authorization Exemption information:
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
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)
For Puerto Rico
If you prefer, you may complete the
Another option is to use the Centers for Medicare & Medicaid Services (CMS)
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:
For additional information about current prior authorizations policies, please reference