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)

Dermatology (A-O)
Download Form (194 KB)

Dermatology (P-Z)
Download Form (190 KB)

Inflammatory Bowel Disease
Download Form (357 KB)

Oncology REMS
Download Form (477 KB)

General Infusion
Download Form (817 KB)

Pulmonary Arterial Hypertension
Download Form (189 KB)

Asthma and Allergy
Download Form (48 KB)

Alpha 1 Antitrypsin Deficiency
Download Form (48 KB)

Oral Oncology General
Download Form (102 KB)

Oral Oncology (A-D)
Download Form (137 KB)

Oral Oncology (E-I)
Download Form (162 KB)

Oral Oncology (J-R)
Download Form (133 KB)

Oral Oncology (S-T)
Download Form (148 KB)

Oral Oncology (U-Z)
Download Form (130 KB)

Growth Hormone
Download Form (252 KB)

Synagis
Download Form (252 KB)

Viscosupplement
Download Form (504 KB)

Hypercholesterolemia
Download Form (233 KB)

General Prescription
Download Form (356 KB)