[one_full last=”yes” spacing=”yes” center_content=”no” hide_on_mobile=”no” background_color=”” background_image=”” background_repeat=”no-repeat” background_position=”left top” border_position=”all” border_size=”0px” border_color=”” border_style=”” padding=”” margin_top=”” margin_bottom=”” animation_type=”” animation_direction=”” animation_speed=”0.1″ class=”” id=””][fusion_text]Originally shared from Humana Connections | September 2015
What do these changes mean?
Some medicines will have new requirements. These requirements include.
The member’s doctor must contact Humana to get approval before they fill or refill a prescription for any medicine that needs prior authorization. Their plan benefits won’t cover this medicine without prior authorization and they’ll pay the entire cost of the medicine if they decide to buy it.
Sometimes there’s more than one medicine that works to treat a health condition. Some medicines may cost less but work just as well. Before a prescription is filled for a medicine that costs more, the member may be asked to try at least one other medicine first.
If the member’s doctor thinks the other medicine isn’t right for them, he or she will need to request approval from Humana to use the medicine that costs more. Their plan benefits won’t cover this medicine without approval and they’ll pay the entire cost of the medicine if they decide to buy it.
Members have a limit on the amount of some medicines they can fill during a period of time. These limits can be placed on some drugs because of safety concerns and help prevent misuse of these drugs. If the member’s prescription is over the limit, there are two choices:
They can get the amount of medicine that’s covered by their plan benefits and then pay out of pocket for any medicine that’s over the limit.
If their doctor thinks more medicine is needed, he or she can ask for approval from Humana for the amount of medicine that goes over the limit.
The member’s medicine(s) is grouped into different tiers. For each tier, they’ll pay a different amount. If members fill or refill a prescription for a medicine that’s moving to a different tier, they may have to pay more or less.
Starting January 1, 2016, some medicine(s) will no longer be on the member’s Drug List. If they fill or refill a prescription for any medicine that isn’t covered under their benefit plan, they’ll have to pay the full cost of the prescription.
The member’s doctor can ask Humana to make an exception to cover their drug if it’s not on our Drug List. Generally, Humana will only approve a request for an exception if the alternative covered drugs wouldn’t be as effective in treating their health condition and/or would cause adverse medical effects. To ask for an exception, their doctor can contact HCPR at 1-800-555-2546 between 8 a.m. and 6 p.m., Monday through Friday.
Why is Humana making these changes?
Humana reviews and updates the Drug List to help ensure safety and offer cost-effective choices for drug benefits. Updates to the Drug List can happen when medicines have changes in dosing and prescribing guidelines. The selection of available medicines may also change. This can happen when a drug is removed from the market by the Food and Drug Administration (FDA) or a drug’s manufacturer, or a new drug becomes available and is added to the Drug List.
*For Texas, Louisiana and Puerto Rico Fully Insured, these changes start on each group’s renewal date in 2016.[/fusion_text][/one_full]