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Are my prescription drugs covered by my Humana plan?

November 03, 2017

If you’re enrolled in a Medicare plan with Humana that includes prescription drug coverage, you may have questions about whether your medications are covered. This is a very important question because if your prescriptions aren’t covered by the plan, you may have to pay for the full cost of those medications out of pocket.

The good news is that it’s easy to look up whether your Medicare plan from Humana covers your prescription drugs. You can do so by checking the formulary, or list of covered drugs. Learn how to look up the Medicare formulary for your Humana plan, where to find it, and how to understand the benefit information in it.

How can I find out if my prescription drugs are covered by my Medicare plan from Humana?

Whether you’re enrolled in a stand-alone Medicare Prescription Drug Plan or a Medicare Advantage Prescription Drug plan, you can find out if your medications are covered by checking the plan’s formulary. Every Medicare plan with prescription drug coverage has one, which, as mentioned, is simply a list that details plan benefits, including covered medications and their costs.

Humana Medicare Advantage plans and stand-alone Medicare Prescription Drug Plans may use a tiered formulary, which assigns lower copayments, coinsurance, and/or deductibles for less expensive medications . Typically, generic drugs will be on lower tiers and may have lower copayments, coinsurance, and deductible costs. Brand-name drugs will usually have higher cost-sharing and be on higher tiers. Depending on the type of Medicare plan you have, you may have to follow additional rules from that plan. For example, your Medicare plan from Humana may require you to use in-network pharmacies to fill your prescriptions. Other Medicare plans offered by Humana may give you the option to use non-network pharmacies, but your costs may be higher.

Keep in mind that formularies may change at any time. Humana will notify you if necessary. Medicare-contracted private insurance companies like Humana must follow certain rules when it comes to making changes to plan formularies, such as giving written notice at least 60 days before the change goes into effect. You can take a look at recent formulary changes to Humana’s plans here.

Plan benefits and availability vary by location, and not every Medicare plan by Humana is offered in every area. You’ll need to keep paying your Part B premium, in addition to any cost-sharing your plan requires for your Medicare Prescription Drug Plan or Medicare Advantage plan.

Where can I look up Humana’s formulary for my Medicare plan?

Formulary information for Humana’s Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug plans is available on its website.

You have a few options for looking up whether your medications are covered:

  • You can find and download the formulary for your Medicare plan here. Search by your plan’s name (for example, Humana Preferred Rx Plan) to find its accompanying formulary.
  • You can use Humana’s Drug List Search tool, available here, to look up your medication by name and related benefit information.

If you need help finding your Medicare plan’s formulary, you can always call Humana for more information. You can find the phone number for Humana’s customer service on the back of your member card.

If you’d like help finding Medicare plans by Humana that may cover your prescription drugs, you are welcome to speak with an eHealth licensed insurance agent about Medicare plans from Humana: call 1- 888-323-1149, TTY users dial 711. Monday through Friday, 8AM to 8PM ET.  Or, to find plan options at your convenience, just enter your zip code into the plan finder tool on this page to get started now.

 

*Out-of-network/non-contracted providers are under no obligation to treat Humana members, except in emergency situations. For a decision about whether Humana will cover an out-of-network service, we encourage you or your provider to ask Humana for a pre-service organization determination before you receive the service. Please call Humana’s customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

Humana is a Medicare Advantage HMO, PPO and PFFS organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any Humana plan depends on contract renewal.

You must continue to pay your Medicare Part B premium.

A plan’s formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums, and/or member cost-share may change on January 1 of each year.

Humana’s pharmacy network offers limited access to pharmacies with preferred cost sharing in urban areas of <AL, CA, CT, DC, DE, IA,  IL, IN, KY, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NH, NJ, NY, OH, OR, PA, RI, SC, SD, TN, VA, VT, WA, WI, WV; suburban areas of AZ, CA, CT, DE, HI, IL, MA, MD, ME, MI, MN, MO, MT, ND, NH, NJ, NY, OH, OR, PA, PR, RI, VT, WA, WV>; and rural areas of <AK, IA, MN, MT, ND, NE, SD, VT, WY>. There are an extremely limited number of preferred cost share pharmacies in urban areas in the following states: <DE, MA, MD, ME, MI, MN, MS, ND, NY, OH, SC, and VT>; suburban areas of: <MT and ND>; and rural areas of: <ND>.  The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including pharmacies with preferred cost sharing, please call Customer Care at <1-800-281-6918 (TTY: 711)> or consult the online pharmacy directory at Humana.com.

Last Updated: 11/3/2017

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