Humana Begins Enforcing Mail Order Prohibition

In July of 2017, Humana updated its Retail Pharmacy Provider Agreement to prohibit the delivery of prescription drugs, Durable Medical Equipment, and prescribed diabetic supplies through mail delivery services. These services include the U.S. Postal Service, UPS, DHL, FedEx, or any similar national, regional, or local common carriers.

PAAS National® is seeing termination notices sent to pharmacies that Humana believes are using mail delivery. Humana is basing these terminations on review of claims submitted by pharmacies to Humana. Likely, Humana is comparing

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the patient’s address to that of the pharmacy, flagging claims it believes are outside the “normal delivery area” (the company is not publicly defining what it considers the delivery area). Also, Humana may choose to use audit data to identify mailed claims.

Humana is providing an opportunity to resolve termination. Pharmacies must sign an attestation confirming and agreeing to cease all mail delivery. Attestations must be signed and submitted within 30 days of the termination notice. Any subsequent violations will result in immediate termination.

PAAS Tip: PAAS is aware of four PBMs that restrict mail delivery:

  • OptumRx – No mail
  • Humana – No mail
  • Express Scripts – No mail, will allow up to 10%
  • Caremark – 25%

Pharmacies may be able to obtain separate mail order agreements or amendments. Prescriptions can still be picked up in-store or delivered to patients’ preferred address using pharmacy employees or contractors.