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Pre-certification

Some drugs require pre-certification before they can be delivered or administered in a physician’s office, clinic, outpatient, or home setting. Pre-certification is required for the drugs listed below.

Request Submission

Doctors can submit their requests to the Humana Medication Intake Team (MIT) through the following methods.

Phone & Fax Requests

Hours 8:30 AM - 5PM EST, Monday – Friday
Phone Requests 1-866-461-7273
Fax Requests Complete the forms below and fax to 1-888-447-3430

General Fax Form

If a drug does not have a custom form below, please use the General Fax Form.

PDF Download PDF
English

Customized Fax Forms

Aloxi IV injection PDF Download PDF
English
 
Aranesp PDF Download PDF
English
 
Arranon PDF Download PDF
English
 
Avastin PDF Download PDF
English
 
Avonex PDF Download PDF
English
 
Betaseron PDF Download PDF
English
 
Copaxone PDF Download PDF
English
 
Enbrel PDF Download PDF
English
 
Epogen PDF Download PDF
English
 
Erbitux PDF Download PDF
English
 
Euflexxa PDF Download PDF
English
 
Humira PDF Download PDF
English
 
Hyalgan PDF Download PDF
English
 
Increlex PDF Download PDF
English
 
IVIG PDF Download PDF
English
 
Kineret PDF Download PDF
English
 
Leukine PDF Download PDF
English
 
Neulasta PDF Download PDF
English
 
Neupogen PDF Download PDF
English
 
Orencia PDF Download PDF
English
 
Orthovisc PDF Download PDF
English
 
Pegasys PDF Download PDF
English
 
Peg-Intron PDF Download PDF
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Procrit PDF Download PDF
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Rebif PDF Download PDF
English
 
Reclast PDF Download PDF
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Remicade PDF Download PDF
English
 
Revlimid PDF Download PDF
English
 
Ribavirin PDF Download PDF
English
 
Rituxan PDF Download PDF
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Somavert PDF Download PDF
English
 
Supartz PDF Download PDF
English
 
Synagis PDF Download PDF
English
 
Synvisc PDF Download PDF
English
 
Vectibix PDF Download PDF
English
 
Vidaza PDF Download PDF
English
 
Xolair PDF Download PDF
English
 
Zometa_Medical PDF Download PDF
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