Tip for Humana FE (plan-specific)

Document all formulary medications the patient has tried and why they failed (side effects, lack of efficacy)

Tip for Humana FE (plan-specific)

For expedited requests, clearly state the risk of serious harm from waiting for a standard review

Tip for Humana FE (plan-specific)

Attach peer-reviewed clinical evidence if the medication is being used for an off-label indication

InsurancemoderateDoctor signature required

Humana Formulary Exception Request

Humana FE (plan-specific) · Humana

Humana-specific request for formulary exception to cover a non-formulary medication or to reduce cost-sharing tier. Requires clinical justification for why formulary alternatives are insufficient.

Form Details

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Where to Submit This Form

🌐

Humana Provider Portal

https://www.humana.com/provider/

Submit through the pharmacy management section of the provider portal.

📠

Fax to Humana Pharmacy Services

Fax: 800-833-7421

Filing Deadline

Submit before or promptly after the medication is prescribed. Standard review within 72 hours; expedited within 24 hours.

Required Attachments

📎 Completed Humana formulary exception request form
📎 Clinical justification explaining why formulary alternatives are not appropriate
📎 Documentation of tried-and-failed formulary medications (if applicable)
📎 Prescriber's letter of medical necessity

Processing Time

Standard: 72 hours. Expedited (risk of serious harm): 24 hours. Medicare Part D: specific CMS-mandated timeframes apply.

What Happens Next

Humana's pharmacy team reviews the request. If approved, the medication is covered at the applicable cost-sharing level. If denied, you receive written notice with appeal rights.

Tips for This Form

✓ Document all formulary medications the patient has tried and why they failed (side effects, lack of efficacy)
✓ For expedited requests, clearly state the risk of serious harm from waiting for a standard review
✓ Attach peer-reviewed clinical evidence if the medication is being used for an off-label indication
✓ If denied, you can appeal through Humana's internal process and then to an independent review entity

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