CurrentHumanaPolicy N/A

Humana Healthy Horizons in Kentucky Prior Authorization and Notification List (Professionally Administered Medications)

Governs prior authorization and notification requirements for professionally administered medications for Humana Healthy Horizons members in Kentucky; applies to providers delivering medications in office, clinic, outpatient, or home settings and excludes other Humana lines of business.

Policy Summary

PayerHumana

PolicyHumana Healthy Horizons in Kentucky Prior Authorization and Notification List (Professionally Administered Medications)

Policy CodePolicy N/A

Change TypeAdministrative update — no material changes

Effective Date01/01/2026

Next Review DateN/A

Key ActionSubmit prior authorization requests by CoverMyMeds portal, Humana portal/phone/fax, or for transplant items use Humana National Transplant Network (fax 502-508-9300; phone 866-421-5663; email transplant@humana.com).

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

01/01/2026Effective date listed

05/27/2026Last review

Kentucky-onlyGeographic scope

Prior auth & notification listDocument type

†/‡/†† flags used

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

502-508-9300Transplant fax

Coverage stance and medication list

High-level coverage stance and provider responsibilities

Medications listed may require prior authorization or notification; urgent/emergent services do not require prior authorization. Absence of required authorization or notification may result in financial penalties or retrospective review.

Medications included on the Professionally Administered Medication PAL commonly require prior authorization or notification before administration, unless otherwise specified in the provider's agreement or plan terms.

'Prior authorization' requires healthcare providers to obtain advance approval from the plan as to whether an item or service may be covered.

'Notification' is distinct from prior authorization; it is a process by which a provider notifies Humana of the intent to provide an item or service and does not constitute approval or denial.

Urgent/emergent services do not require a referral or prior authorization.

Providers are advised to verify benefits and prior authorization requirements with Humana prior to providing services; failure to obtain required authorization/notification prior to the date of service could result in financial penalties or reduced member benefits and may trigger retrospective medical necessity review.

Coverage and billing notes (extract)

Provider-administered medication entries map brand -> generic -> code and include billing and routing annotations; certain codes and items have specific billing or preauthorization routing requirements.

Each medication entry is presented as: Brand name -> Generic name -> Code (HCPCS/J/Q/A/etc).

Shared HCPCS and 'not otherwise classified' codes require a corresponding National Drug Code (NDC) to be billed on all claims (indicated by ‡).

The symbol † indicates a new-to-market drug addition.

Items flagged with †† require preauthorization review by the Humana National Transplant Network; contact methods (fax 502-508-9300, phone 866-421-5663, email transplant@humana.com) and hours are provided for submission.

Examples from the medication list (illustrative mapping): Gazyva -> obinutuzumab -> J9301; Granix -> tbo-filgrastim -> J1447; Herceptin (IV) -> trastuzumab -> J9355; Growth hormones (various brands) -> somatropin -> J2941.

Examples of HCPCS / J / Q codes

Sample HCPCS/Q Codesmixed

J9264	Abraxane
Q2055	Abecma

Selected HCPCS/J Codes (covered | neutral)HCPCS

J9301	obinutuzumab (Gazyva)
J7326	sodium hyaluronate (Gel-One)
J0223	givosiran (Givlaari)
J1447	tbo-filgrastim (Granix)
J2941	somatropin (growth hormones list)
J0801	corticotropin (H.P. Acthar Gel)
J9355	trastuzumab (Herceptin IV)
J1442	filgrastim (Neupogen)
J2506	pegfilgrastim (Neulasta)
J2778	ranibizumab (Lucentis)

Selected HCPCS/J CodesHCPCS

J2326	nusinersen (Spinraza)
J3358	ustekinumab IV / shared HCPCS
J1303	ravulizumab-cwvz (Ultomiris)
J7173	concizumab-mtci (Alhemo)
J7192	antihemophilic factor, human (Advate / others)

How to submit requests and special routing

Prior Authorization

Submission methods and special routing

Prior authorization requests for provider‑administered medications can be submitted by web, phone, or fax. For patients 18 years and older receiving chemotherapy agents and supportive/system management drugs, Humana partners with Evolent Health and those requests must be submitted via the Evolent Provider Portal, by phone at 844-926-4528 (option 3), or by fax to 877-624-0611. Transplant-related preauthorization requests are reviewed by the Humana National Transplant Network and follow separate routing.

General prior authorization submissions: web, phone, or fax.
Adult oncology chemotherapy/supportive drugs (age ≥18): submit via Evolent Provider Portal, phone 844-926-4528 (option 3), or fax 877-624-0611.
Transplant preauthorization follows separate Humana National Transplant Network routing.

Documentation Required

Notification vs prior authorization

Notification is a separate process from prior authorization; it is requested to help coordinate care and does not represent an approval or denial of coverage.

Key terms and symbol legend

Prior authorization — definition of prior authorization process

DefinitionPrior authorization (also preauthorization, precertification, preadmission) is a process requiring healthcare providers to obtain advance approval from the plan as to whether an item or service may be covered.

PurposeEnsures the plan reviews clinical information before services or medications are provided to determine coverage responsibility.

ApplicabilityApplies to medications delivered in the provider's office, clinic, outpatient, or home setting as listed in this document.

Notification — definition of notification process and distinction from prior authorization

DefinitionNotification is the process through which a healthcare provider notifies Humana of the intent to provide an item or service; Humana requests notification to help coordinate care.

Policy Summary

PayerHumana

PolicyHumana Healthy Horizons in Kentucky Prior Authorization and Notification List (Professionally Administered Medications)

Policy CodePolicy N/A

Change TypeAdministrative update — no material changes

Effective Date01/01/2026

Next Review DateN/A

SourceLink

On This Page

Notification: provider notifies Humana of intent to provide an item or service; Humana does not issue approval or denial for notifications.
Prior authorization: a request for advance approval as to whether an item or service may be covered.

Prior Authorization

Transplant network preauthorization contact methods

Preauthorization requests that require review by the Humana National Transplant Network may be submitted by fax, phone, or email for review by that network.

Fax: 502-508-9300
Phone: 866-421-5663, Monday–Friday, 7 a.m.–7 p.m. Central time
Email: transplant@humana.com

Prior Authorization

Transplant network preauthorization submission instructions

Preauthorization requests submitted for review by the Humana National Transplant Network can be sent by fax, by phone during listed hours, or by email to the transplant review team.

Fax: 502-508-9300
Phone: 866-421-5663, Monday–Friday, 7 a.m.–7 p.m. Central time
Email: transplant@humana.com

Documentation Required

Prior authorization fax forms access

Fax request forms to request prior authorization or to provide notification are available and can be accessed from Humana's prior authorization for professionally administered drugs website.

You can fax requests to 888-447-3430 (request forms are available on Humana's prior authorization for professionally administered drugs website).
General note: 'You can access the fax forms to request prior authorization or provide notification.'

Distinction from prior authorization

A notification does not constitute approval or denial and is different from prior authorization, which requires advance plan approval.

Use caseUsed to coordinate care for Humana-covered patients rather than to establish coverage eligibility.

† symbol definition — new-to-market drug addition

Symbol† (dagger) indicates a new-to-market drug addition.

Where shownAppears next to product names on the professionally administered medication list to denote recently added agents.

ReferenceSee medication entries flagged with † in the PAL for new-to-market status.

shared HCPCS codes / not otherwise classified codes require corresponding NDC on claims

Symbol‡ indicates that all shared HCPCS codes and not otherwise classified (NOC) codes require a corresponding National Drug Code (NDC) to be billed on all claims.

†† symbol definition — items reviewed by Humana National Transplant Network with contact methods provided

Contact methodsRequests can be submitted by fax (502-508-9300), by phone (866-421-5663, Mon–Fri 7 a.m.–7 p.m. Central), or by email (transplant@humana.com).

Billing requirement for shared HCPCS/unspecified codes — NDC required when billing shared HCPCS or NOTC codes

RequirementWhen billing shared HCPCS or not otherwise classified (NOC) codes, providers must include the corresponding National Drug Code (NDC) on all claims.

PurposeEnsures the drug/product is specifically identified on the claim to support appropriate adjudication and reimbursement.

Symbol legend — consolidated meanings for †, ‡, †† and related notes

†New-to-market drug addition.

‡All shared HCPCS codes and not otherwise classified (NOC) codes require a corresponding National Drug Code (NDC) to be billed on all claims.

NoteLegend repeated with each section of the PAL to clarify annotation meanings and routing instructions.