The Clinical Policy and Pharmacy & Therapeutics areas of Humana are responsible for developing Humana's medical and pharmacy coverage policies regarding emerging medical technologies (devices and procedures) and medications using the practice of evidence-based medicine.

Creating Humana's Medical and Pharmacy coverage policies begins with a clinical researcher conducting an extensive review of the medical literature including but not limited to:

• Peer-reviewed medical journals
• The National Library of Medicine
• Specialty organizations, opinions, national treatment guidelines and AMCP dossier
• Medical research web sites
• Medical textbooks

The researcher then creates a coverage policy based on an analysis of the research available. The resulting policy is presented on a periodic basis to Humana's Technology Assessment Forum (TAF) or Pharmacy &Therapeutics (P&T) committees for acceptance or modification.

The TAF committee is comprised of Humana medical directors, practicing physicians, representatives from legal, claims, customer service and provider contracting. The P&T committee is comprised of Humana medical directors, pharmacists, an outside geriatric pharmacist, and an outside practicing physician who has significant experience in treating geriatric patients. Upon acceptance by TAF or P&T, the coverage policy becomes Humana policy.

Medical and Pharmacy coverage policies are created with the following understanding:

• Federal and state laws may dictate certain coverage.
• A member's certificate or contract determines what benefit he/she is eligible for.
• The Medical and Pharmacy coverage policies apply to the majority of members but individual consideration may be appropriate.