Using the Humana Formulary (Drug List): Are My Prescriptions Covered?

As you compare your Medicare Advantage (Medicare Part C) plan options, you may want to consider your prescription drug coverage needs.

• Do you take prescription drugs?
• How often do you take prescription drugs?
• Do you prefer a Medicare Advantage plan that can help cover some of your prescription drug costs?

Each 2024 Humana Medicare Advantage plan with prescription drug coverage will offer its own list of covered drugs and guidelines for how these drugs are covered. This list is called a formulary.

If you want help finding a Humana Medicare Advantage plan that may include coverage for your prescription drugs, speak with a licensed insurance agent¹ by calling 1-800-472-2986 TTY Users: 711 24 hours a day, 7 days a week, or you can request a free plan quote online, with no obligation to enroll in a plan.

Read more below to learn how you can use the Humana Drug List to find out if your prescription drugs are covered by a Humana Medicare Advantage plan.

About the Humana Drug List

The Humana Drug List contains the most widely prescribed drugs covered by Humana. The formulary is updated by doctors and pharmacists on a regular basis as new medications are introduced or others are removed. Updates to the current formulary are posted monthly.

Humana Medicare Advantage plans that offer prescription drug coverage may use a tiered drug list, which means that less expensive medications on a lower tier may be covered with lower copayments, coinsurance or deductibles.

Your Humana Medicare Advantage plan drug list might include coverage guidelines such as the following:

• Generic drugs may often be on a lower tier with lower out-of-pocket costs.
• Name-brand drugs may be on a higher tier with higher copayments, coinsurance or deductibles.
• Depending on which plan you have, some Humana Medicare Advantage plans with prescription drug coverage may require you to visit a pharmacy that is in the plan network.
• Some plans may allow you to visit pharmacies outside of the plan network, but your out-of-pocket costs could potentially be higher.

Not every Humana Medicare Advantage plan offers prescription drug coverage, and plan coverage and benefits may vary based on your location.

How do I find out if my Humana Medicare Advantage plan covers my prescription drugs?

Two ways you can find out which prescription drugs may be covered by which Humana Medicare Advantage plan include:

• View the Humana Drug List
  You can view and print out the full list of drugs covered by Humana (called the Humana Prescription Drug Guide). You can also have it delivered to you by mail.
  
  To view the list, select your state and your Humana Medicare Advantage plan to view the online plan drug list and other drug guides. You will need Adobe Reader to view and print the documents.
  
  If you have a Humana Medicare Advantage plan, you can request to have the Humana Drug List delivered to you by mail by filling out the printed materials request form.
  
  
• Search for a particular drug
  If you want to see if a specific drug is covered by a particular Humana plan, you can use the online Humana Medicare Drug List Search tool to perform your search.
  
  You can select as many plans as you wish to include in your search and then enter the name of the drug to see which plans provide coverage for the chosen drug.

As mentioned above, a licensed insurance agent¹ can help you compare Medicare Advantage plans that are available in your area and the prescription drug coverage those plans may offer. Call 1-800-472-2986 TTY Users: 711 24 hours a day, 7 days a week, or you can request a free plan quote online, with no obligation to enroll in a plan.

Humana offers potential savings opportunities on prescription drugs

Members of Humana Medicare Advantage plans that include prescription drug coverage can access a number of personalized prescription programs and benefits.

These programs and tools can include the following:

• The Humana mail-delivery pharmacy, CenterWell Pharmacy™, can help you save money as the preferred cost-sharing pharmacy for many Humana Medicare Advantage plans that include prescription drug coverage.
• SmartSummary RX^® can help you manage your drug costs by sending you a monthly summary of your prescription spending.
• Drug pricing tools and a pharmacy finder tool can help you compare your drug costs with several pharmacies near you.

Requesting coverage for a specific drug  

If a drug that you need is not listed on the Humana Prescription Drug Guide, you are not entirely out of luck.

If you have a Humana Medicare Advantage plan, you may contact the Humana Clinical Pharmacy Review at 1-800-555-2546 or the Customer Care phone number on the back of your Humana ID card to request coverage for any medication not on Humana’s list of covered drugs.

You may also fill out the coverage determination form and mail or fax it to the address or fax number provided on the top of the form.

Prior authorization of prescription drugs

There may be times when an approval from Humana must be obtained before having a specific prescription filled. This is called “prior authorization” and is one way to help make sure you are getting the right treatment for your condition.

There are several reasons why a prior authorization may be required for a prescription:

• State or federal guidelines may require a review of certain prescriptions.
• There may be a more affordable medication available that can be used to treat the same condition.
• The medication prescribed might contain side effects or require special monitoring.
• The medication prescribed might be dangerous when mixed with another drug.
• The medication prescribed carries an increased risk of abuse or misuse.

The drugs that require prior authorization will be noted on the Prescription Drug Guide. Your doctor will be able to file a request for prior authorization, but you may also request a prior authorization online.  

How do I find a Humana Medicare Advantage plan that covers prescription drugs?

A licensed insurance agent¹ can review your Medicare coverage options and help you find a plan with prescription drug coverage. There are certain times of year during which you may be eligible to enroll in a plan, depending on your personal circumstances. You can reach a licensed insurance agent¹ directly at 1-800-472-2986 TTY Users: 711 24 hours a day, 7 days a week, or you can get started by requesting a free plan quote online, with no obligation to enroll in a plan.