MedicaidPrior AuthMedium impact
Non-Preferred Exceptions (Revised)
Humana·IN · Pharmacy·Medicaid
Effective date
Jul 1, 2024
We identified it
Jun 24, 2026
Summary
Humana updated their Medicaid pharmacy non-preferred exception process, establishing 24-hour turnaround requirements and allowing pharmacists to provide 3-4 day emergency supplies when prior authorization cannot be immediately obtained. The policy clarifies submission procedures through phone, fax, or electronic systems.
Action Required
Immediately: Pharmacy staff must use submission clarification codes SCC 65 or SCC 03 for emergency 3-4 day supplies when prior authorization denials occur at point of sale. Billing team should expect 24-hour turnaround on non-preferred exception decisions and ensure prescribers submit complete medical necessity documentation including why formulary alternatives are ineffective or harmful.