Methods to initiate prior authorization

Prior authorization requests for medications may be initiated online via CoverMyMeds, by phone at 866-461-7273 (TTY: 711), Monday–Friday, 8 a.m.–11 p.m. Eastern time, or by fax to 888-447-3430. Request forms are available on Humana's prior authorization for professionally administered drugs website.

• Online: CoverMyMeds
• Phone: 866-461-7273 (TTY: 711), Mon–Fri 8 a.m.–11 p.m. ET
• Fax: 888-447-3430 (use Humana PA fax forms)

Information required for prior authorization requests

Submit complete patient identifiers and service details with each prior authorization or notification request; include HCPCS and diagnosis codes, service date and location, provider and facility TIN/NPI, caller contact, and relevant clinical information to expedite determinations.

• Patient name, date of birth, Humana member ID
• Date of actual service or hospital admission
• HCPCS code(s) and diagnosis codes (up to 6)
• Service location (inpatient/outpatient/home/etc.)
• TIN and NPI of facility and provider performing service
• Caller/requester name and phone number and attending provider phone
• Relevant clinical information

Denial risk and delegated network note

Failure to obtain required prior authorization may result in financial penalties to the practice, reduced patient benefits, and retrospective review; delegated IPAs and risk networks are subject to the PAL and should follow their network guidance.

• Urgent/emergent services do not require prior authorization
• Delegated IPA/risk network providers must follow PAL and their network guidance

Use fax forms for sample medication entries

Access Humana's fax forms to request preauthorization or provide notification for listed medications; examples in the list include eculizumab-aeeb (Bkemv IV, Q5152), belantamab mafodotin-blmf (Blenrep, C9399/J3490/J3590/J9999), blinatumomab (Blincyto, J9039), denosumab-bnht (Bomyntra, Q5158), and bortezomib (J9046).

• Example entries: Bkemv IV (eculizumab-aeeb) — Q5152
• Blenrep (belantamab mafodotin-blmf) — C9399, J3490, J3590, J9999
• Blincyto (blinatumomab) — J9039
• Bomyntra (denosumab-bnht) — Q5158
• bortezomib — J9046

CAR‑T and specialty therapy prior authorization via fax forms

CAR-T and other specialty therapies listed (marked ††) require prior authorization and should be submitted using the listed fax forms; examples include Carvykti (ciltacabtagene autoleucel, Q2056) and Casgevy (exagamglogene autotemcel, J3392).

• Carvykti (ciltacabtagene autoleucel) — Q2056 (††)
• Casgevy (exagamglogene autotemcel) — J3392 (††)

Submission notes and special program annotations

Submission annotations and program notes: * = new preauthorization requirement; † = new-to-market drug; ‡ = shared HCPCS/NOC codes require a corresponding NDC on all claims; ** = step therapy required through a Humana-preferred drug as part of preauthorization; †† = transplant-reviewed items are routed to the Humana National Transplant Network.

• * New preauthorization requirement
• † New-to-market drug addition
• ‡ Shared HCPCS/NOC codes require NDC on claims
• ** Step therapy required through a Humana-preferred drug
• †† Transplant items reviewed by Humana National Transplant Network

Medication listings and PA requirement examples

Providers must request prior authorization for the drugs listed in the PAL; entries include generic medication name and billing codes (examples: immune globulin products J1566/J1569/J1561, Gammaplex J1557, Gazyva J9301, Gel‑One J7326).

• Immune globulin — J1566, J1569, J1561
• Gammaplex — J1557
• Gazyva (obinutuzumab) — J9301
• Gel‑One (sodium hyaluronate) — J7326

Annotations and PA submission notes

Legend and submission implications: entries flagged with symbols require special submission handling (e.g., ‡ entries require NDC billing on claims; ** entries may require step therapy documentation). Providers should follow the legend when preparing PA requests.

• ‡ — include corresponding NDC on claims for shared HCPCS/NOC codes
• ** — step therapy may be required; document trials of preferred drugs
• * / † — indicate new PA requirement or new-to-market additions

Transplant and fax form instructions

For transplant-related and other complex therapies (††), access the Humana fax forms to request preauthorization or provide notification; the Humana National Transplant Network reviews these requests and provides dedicated contact channels.

• Use Humana PA fax forms for transplant-related items
• Humana National Transplant Network handles †† items

General PA billing and step therapy requirements

All shared HCPCS codes and not otherwise classified codes require a corresponding National Drug Code (NDC) to be billed on claims; step therapy may be required for some drugs and new PA requirements are indicated in the list.

• ‡ — NDC must be billed on all claims for shared HCPCS/NOC codes
• ** — step therapy may apply through Humana‑preferred drugs

Transplant preauthorization submission instructions

Transplant preauthorization requests are reviewed by the Humana National Transplant Network and may be submitted by fax to 502-508-9300, by phone at 866-421-5663 (Mon–Fri 7 a.m.–7 p.m. CT), or by email to transplant@humana.com.

• Fax: 502-508-9300
• Phone: 866-421-5663, Mon–Fri 7 a.m.–7 p.m. CT
• Email: transplant@humana.com

How to request prior authorization for listed drugs

Use Humana's fax forms to request prior authorization or provide notification for each listed drug; every drug entry in the list includes the generic medication name and its associated billing code(s) to include on the request.

• Include the drug's generic name and billing code(s) on the PA request
• Access the specific fax form referenced in the PAL for that drug

Medication prior authorization entries (sample)

Sample medication entries shown in the PAL list require prior authorization or notification and include billing codes; examples include romidepsin (J9318), Ruconest (C1 esterase inhibitor, J0596), Ruxience (rituximab-pvvr, Q5119), and Rybrevant IV (J9061).

• romidepsin — J9318
• Ruconest (C1 esterase inhibitor) — J0596
• Ruxience (rituximab-pvvr) — Q5119
• Rybrevant IV (amivantamab-vmjw) — J9061

Legend and special routing

The PAL legend explains the routing and special markers: * = new PA requirement; † = new-to-market drug; ‡ = shared HCPCS/NOC codes require NDC; ** = step therapy required; †† = transplant-reviewed with Humana National Transplant Network contact details.

• * new preauthorization requirement
• † new‑to‑market drug addition
• ‡ NDC required for shared HCPCS/NOC codes
• ** step therapy required through a Humana‑preferred drug
• †† transplant review routing

Transplant preauthorization contact and routing

Humana National Transplant Network contact for †† items: fax 502-508-9300; phone 866-421-5663 (Mon–Fri 7 a.m.–7 p.m. CT); email transplant@humana.com. Use these channels for transplant-related preauthorization submissions.

• Fax: 502-508-9300
• Phone: 866-421-5663, Mon–Fri 7 a.m.–7 p.m. CT
• Email: transplant@humana.com

Prior authorization request instructions and special notes

Prior authorization requests must reflect any new PA requirements or step therapy expectations noted in the PAL; providers should include step therapy documentation when an entry is marked with ** and ensure shared HCPCS/NOC codes include the corresponding NDC on claims.

• Document prior trials of Humana‑preferred drugs for ** (step therapy) items
• Include NDC on claims for ‡ (shared HCPCS/NOC) items

Vyxeos (J9153) prior authorization example

Drug‑specific example: Vyxeos (daunorubicin/cytarabine) requires prior authorization; include billing code J9153 on the request and use Humana's fax form to submit the preauthorization or notification.

• Vyxeos (daunorubicin/cytarabine) — J9153
• Submit via Humana PA fax form to request preauthorization or provide notification

Zynyz (J9345) prior authorization example

Drug‑specific example: Zynyz (retifanlimab-dlwr) requires prior authorization; include billing code J9345 and submit using the appropriate Humana fax form to request preauthorization or provide notification.

• Zynyz (retifanlimab-dlwr) — J9345
• Use Humana PA fax form to request preauthorization or provide notification