Physician Fax Forms

Ask your doctor to fill out and fax your new prescription (using one of the fax forms below) to us at 1-877-405-7940.
Humana Pharmacy Specialty will only accept faxes from providers.

Hemophilia
Download Form (126 KB)

IVIG
Download Form (126 KB)

MS
Download Form (252 KB)

Hepatitis C
Download Form (361 KB)

IV Rheumatology
Download Form (289 KB)

Rheumatology Self-Administered
Download Form (504 KB)

Psoriasis
Download Form (360 KB)

Inflammatory Bowel Disease
Download Form (357 KB)

Hemotalogic Malignancy
Download Form (477 KB)

General Infusion
Download Form (817 KB)

Xolair
Download Form (48 KB)

Alpha 1 Antitrypsin Deficiency
Download Form (48 KB)

Oral Oncology
Download Form (252 KB)

Growth Hormone
Download Form (252 KB)

Synagis
Download Form (252 KB)

Vicosupplement
Download Form (504 KB)

Pulmonary Arterial Hypertension
Download Form (189 KB)

Hypercholesterolemia
Download Form (233 KB)

General Prescription
Download Form (356 KB)