Does Humana Cover ADHD Treatment in Maine? A 2026 Guide

Last updated: July 20, 2026

If you have a Humana plan in Maine and you or a family member is seeking ADHD treatment, understanding your coverage is the first step toward getting care. Humana operates exclusively as a Medicare Advantage (MA) plan carrier in Maine. It exited the commercial individual and small-group market. So this guide focuses on Medicare Advantage coverage under the Humana platform, including how its pharmacy benefit manager, Humana Pharmacy Solutions (HPS), handles ADHD medications.

Quick facts. Humana ADHD coverage in Maine (2026)

• Plan type: Medicare Advantage (MA) only. Humana does not offer commercial plans in Maine
• Pharmacy benefit manager: Humana Pharmacy Solutions (HPS)
• Governing regulation: CMS 42 CFR Part 422 (federal Medicare Advantage rules. Not Maine § 2749-A)
• Prior authorization: All stimulant ADHD medications typically require PA under HPS
• Maine EPCS: Schedule II stimulants require electronic prescribing; non-stimulants are non-scheduled (EPCS inapplicable)
• Dual-eligible patients: Some Medicare beneficiaries also qualify for Maine Medicaid. See Medicaid disclaimer below
• Key contacts: Humana 1-800-448-6262 · HPS 1-800-379-0092 · Maine Bureau of Insurance 1-800-300-5000

Humana in Maine: Medicare Advantage only

Humana withdrew from Maine’s commercial insurance market and now serves the state exclusively through Medicare Advantage plans. If you are under 65 or covered through an employer plan, Humana is not your insurer in Maine. This guide is relevant for Medicare-eligible individuals (age 65+, or under 65 with qualifying disability) enrolled in a Humana MA plan that includes Part D drug coverage.

Humana MA plans in Maine bundle medical benefits (Part A and Part B) with prescription drug coverage (Part D) into a single plan. ADHD medication coverage flows through the Part D component, administered by HPS.

Federal vs. state parity law: why § 2749-A does not apply

Maine’s primary mental health parity statute, Me. Rev. Stat. Ann. tit. 24-A, § 2749-A, governs fully-insured commercial insurance plans regulated at the state level. Because Humana MA plans are Medicare Advantage products, they are governed by federal law. Specifically CMS regulations at 42 CFR Part 422. Not by § 2749-A. Federal preemption applies.

Under CMS 42 CFR Part 422, Humana MA plans are required to:

• Cover Medicare-covered services, including medically necessary mental health services, under the same terms as traditional Medicare
• Apply the federal Mental Health Parity and Addiction Equity Act (MHPAEA) as incorporated into Medicare Advantage rules
• Provide access to ADHD evaluation and treatment at parity with comparable medical/surgical benefits
• Follow CMS coverage determination and appeal procedures (not Maine’s commercial insurance appeal process)

In practice, this means ADHD evaluations, psychiatric or primary care visits for ADHD management, and ADHD medications through HPS Part D may all be covered. Subject to plan-specific cost-sharing, prior authorization, and formulary requirements.

Maine EPCS requirement for ADHD medications

Maine imposes a broad Electronic Prescribing for Controlled Substances (EPCS) mandate under Me. Rev. Stat. Ann. tit. 24-A (Schedule II. V). This is one of the broadest EPCS mandates in the United States. For ADHD medications, the practical impact depends on the drug’s DEA schedule:

Key takeaway for telehealth patients: If your provider is seeking to prescribe a Schedule II stimulant in Maine, they must be EPCS-certified. Telehealth providers at platforms like Klarity Health operate with EPCS capability in all states where it is required. If a non-stimulant ADHD medication is appropriate for your treatment, Maine’s EPCS requirement does not apply, and standard electronic prescribing is sufficient.

HPS ADHD formulary under Medicare Part D

ADHD medications are generally covered under Humana’s Part D formulary administered by HPS. Unlike weight loss medications, which were historically excluded from Medicare Part D. Below is a representative summary of how common ADHD medications may be covered. Specific tier placement and PA requirements can vary by plan year and individual plan (e.g., Humana Gold Plus, Humana PPO). Always verify your specific plan’s formulary at humana.com or by calling HPS at 1-800-379-0092.

Tier and PA information is representative for 2026 Humana MA Part D plans and may vary by specific plan. Verify current formulary status by calling HPS at 1-800-379-0092 or checking your plan’s Evidence of Coverage (EOC).

Prior authorization for ADHD medications under HPS

Under Humana Pharmacy Solutions, prior authorization is typically required for all stimulant ADHD medications. Both generic and brand-name formulations. This is consistent across Humana’s Medicare Advantage Part D plans. PA criteria for ADHD stimulants under HPS generally include:

• Confirmed ADHD diagnosis: Documentation of ADHD (DSM-5 criteria) by a licensed prescriber
• Age and indication: Most HPS PA criteria are written for adults 18+ for standard ADHD indications
• Prescriber type: Prescriptions may be accepted from primary care providers, psychiatrists, or other licensed prescribers with ADHD management scope
• Step therapy: For brand-name stimulants (e.g., Vyvanse brand), HPS may require documentation of a prior trial of a generic stimulant at adequate dose and duration
• Quantity limits: Monthly supply limits are common for Schedule II stimulants under Medicare Part D
• Medicare Part D rules: Because these are Schedule II controlled substances, CMS regulations impose additional dispensing restrictions (e.g., 30-day supply maximum, no refills)

How to initiate PA with HPS

1. Prescriber submits PA request: Your provider calls HPS at 1-800-379-0092 or submits electronically through their EHR/fax portal
2. Clinical documentation submitted: ADHD diagnosis, symptom history, prior treatment records, functional impairment documentation
3. HPS review: Standard review is typically 72 hours; urgent review (if clinically necessary) may be expedited to 24 hours under CMS Part D timelines
4. Coverage determination issued: You and your prescriber receive written notice of approval, denial, or request for additional information
5. Fill prescription: Once approved, your prescriber sends the EPCS-compliant prescription to your pharmacy of choice

Medicare Advantage ADHD medical benefits

Beyond prescription coverage, Humana MA plans typically cover ADHD-related medical services under the Part A/B benefit:

• ADHD evaluation and diagnosis: Psychiatric or primary care evaluation for ADHD, including cognitive and behavioral assessment
• Outpatient mental health visits: Follow-up medication management appointments with a psychiatrist or licensed prescriber
• Telehealth services: Under CMS telehealth expansions extended through 2026, Medicare Advantage members may access mental health evaluation and medication management via telehealth
• Behavioral health counseling: Outpatient counseling for ADHD-related executive function, organizational strategies, and co-occurring conditions (anxiety, depression)
• Preventive mental health screening: Annual wellness visits typically include depression and cognitive screening; ADHD can be identified and referred during these visits

Cost-sharing for mental health services under Humana MA plans must meet federal parity requirements under CMS 42 CFR Part 422. Copays or coinsurance for outpatient mental health visits should not be more restrictive than for comparable medical/surgical outpatient visits.

Medicaid disclaimer: dual-eligible patients

Some Medicare beneficiaries in Maine are also eligible for Maine Medicaid (MaineCare). These individuals are referred to as “dual-eligible.” If you qualify for both Medicare and MaineCare, your ADHD medication coverage may be coordinated between the two programs, and you may have access to a broader formulary or lower cost-sharing than Medicare Part D alone. For information about MaineCare ADHD coverage or dual-eligible coordination, contact:

• Maine DHHS / Office of MaineCare Services: 1-800-977-6740
• Maine Bureau of Insurance (coverage complaints): 1-800-300-5000
• Medicare helpline (CMS): 1-800-633-4227

Coverage varies significantly between dual-eligible and Medicare-only enrollees. Patients should verify their specific benefits before booking appointments or filling prescriptions.

How to verify your Humana ADHD coverage in Maine

1. Call Humana Member Services: 1-800-448-6262. Ask specifically about your plan’s ADHD medication coverage, PA requirements, and formulary tier for the medication your provider has recommended.
2. Call HPS directly: 1-800-379-0092. HPS can confirm current formulary status, PA criteria, and whether your specific medication requires step therapy.
3. Review your Evidence of Coverage (EOC): Your annual EOC document lists covered services, cost-sharing, and formulary details. Available at humana.com or by calling Member Services.
4. Check the HPS online formulary: Humana’s plan finder at humana.com/pharmacy allows you to search your specific medication by plan.
5. Ask your provider to submit a coverage inquiry: Your prescriber can contact HPS to confirm PA requirements before your appointment.

If your ADHD coverage is denied: appeal rights under Medicare

Medicare Advantage members have robust federal appeal rights under CMS regulations. If HPS denies a PA request or a pharmacy claim for an ADHD medication, you have the following options:

1. Request a coverage redetermination (Level 1 appeal): Submit a written appeal to Humana within 60 days of the denial. Standard timeframe: 7 days. Expedited (urgent): 72 hours if delay would seriously jeopardize health.
2. Peer-to-peer review: Your prescriber can request a peer-to-peer clinical review with HPS medical staff before or after a denial. This often resolves PA issues for complex ADHD presentations.
3. Reconsideration by an Independent Review Entity (IRE): If Humana upholds its denial, the case automatically goes to a CMS-contracted IRE (currently Maximus Federal Services) for independent review.
4. ALJ hearing: If the IRE upholds the denial and the amount in controversy meets the threshold, you may request an Administrative Law Judge hearing.
5. Exception request: If your medication is not on the formulary or requires step therapy that is clinically inappropriate, your prescriber can request a formulary exception or step therapy exception on your behalf.

Maine Bureau of Insurance note: Because Humana MA is governed by federal CMS regulations (42 CFR Part 422), coverage disputes go through the federal Medicare appeal process rather than through the Maine Bureau of Insurance. However, the Maine BoI (1-800-300-5000) can assist with general insurance questions and help you understand whether your plan is complying with applicable federal requirements.

How Klarity Health may help with ADHD treatment

Klarity Health connects patients with a network of 2,000+ licensed providers across the United States, including Maine, who specialize in ADHD evaluation and medication management. Klarity Health providers are equipped to:

• Conduct telehealth ADHD evaluations using evidence-based assessment tools
• Prescribe Schedule II stimulant medications via EPCS-certified systems, meeting Maine’s electronic prescribing mandate
• Prepare clinical documentation to support prior authorization submissions to HPS
• Manage ADHD medication prescriptions on an ongoing basis via telehealth follow-up visits
• Coordinate with your Humana plan for coverage verification and PA assistance

Frequently asked questions

Does Humana cover ADHD medication in Maine?

Humana’s Medicare Advantage plans in Maine typically cover ADHD medications through the HPS Part D formulary, subject to prior authorization and formulary requirements. Coverage may vary by specific plan. Contact HPS at 1-800-379-0092 to verify your plan’s formulary status for a specific medication.

Does Maine’s mental health parity law (§ 2749-A) apply to Humana?

No. Maine § 2749-A governs commercially-insured, state-regulated plans. Humana operates in Maine as a Medicare Advantage plan under federal CMS jurisdiction (42 CFR Part 422), not state insurance law. Federal MHPAEA parity protections apply instead.

Do I need EPCS for my ADHD prescription with a Humana plan?

Yes, if you are prescribed a Schedule II stimulant (Adderall, Ritalin, Vyvanse, Concerta, Dexedrine) in Maine, your prescriber must use EPCS regardless of your insurance. Maine’s EPCS mandate applies to all Schedule II. V prescriptions. This is a state law requirement, not a Humana requirement. Non-stimulant ADHD medications are non-scheduled and do not require EPCS.

Can I get ADHD treatment through telehealth with Humana in Maine?

CMS telehealth flexibilities extended through 2026 allow Medicare Advantage members to access mental health evaluation and medication management via telehealth, including ADHD. Your Humana plan should cover telehealth ADHD visits under the Part B mental health benefit, subject to applicable cost-sharing.

What if Humana denies my ADHD medication PA?

You have the right to appeal through the federal Medicare appeal process. Your prescriber can request a peer-to-peer review with HPS, and you can submit a formal coverage redetermination (Level 1 appeal) within 60 days of the denial. If the denial is upheld, the case proceeds to an independent IRE review. Contact Humana at 1-800-448-6262 for appeal instructions specific to your plan.

I have both Medicare and Maine Medicaid. Which covers my ADHD medication?

Dual-eligible patients may have ADHD medication covered through Medicare Part D (via HPS) with MaineCare potentially covering cost-sharing or providing additional coverage. Contact Maine DHHS at 1-800-977-6740 and Humana at 1-800-448-6262 to understand how your specific dual-eligible coverage coordinates for ADHD medications.

Key contacts

• Humana Member Services: 1-800-448-6262
• Humana Pharmacy Solutions (HPS): 1-800-379-0092
• Maine Bureau of Insurance: 1-800-300-5000
• Maine DHHS / MaineCare (dual-eligible): 1-800-977-6740
• CMS Medicare helpline: 1-800-633-4227
• DOL EBSA (ERISA plans): 1-866-444-3272

Coverage information reflects publicly available Humana and CMS guidelines as of July 2026. Plan-specific details may vary. Coverage is not guaranteed. Verify your specific benefits directly with Humana (1-800-448-6262) or HPS (1-800-379-0092) before scheduling appointments or filling prescriptions. This content is for informational purposes only and does not constitute insurance, legal, or medical advice.