Upon 2020 renewal dates, Harvard Pilgrim will implement the Core NH 5-Tier formulary for all New Hampshire small group and individual market customers who currently have the Value formulary.
This new formulary is designed specifically for the New Hampshire market. It gives us more flexibility to make changes based on local needs, and it aligns us with common trends and practices. The Core NH 5-Tier formulary was developed to provide sufficient access to medications in all therapeutics areas while promoting utilization of the most cost-effective medications.
We expect less than 2% of Harvard Pilgrim New Hampshire’s total small group and individual population to have some kind of disruption related to the formulary change. We will notify impacted members 60 days ahead of their renewal to let them know how they will be affected.
- Some members will have their current drugs covered at a higher tier on the Core NH 5-Tier formulary.
- Others will have drugs that are not covered on the Core NH 5-Tier formulary, and they will be directed to consult with their prescribers to discuss alternatives. A small number will be granted a proactive exception and have their drugs covered at the highest cost-sharing level.
Groups who have affected members will receive a letter telling them that they cover members who will experience disruption with the move to the Core NH formulary. These letters will go out 75 days prior to renewal.
All small group and individual subscribers will be notified that their coverage will include the Core NH formulary in 2020.
Members can call Member Services with questions or visit harvardpilgrim.org/2020CoreNH5T for information on exceptions and to find out how any other drugs they take will be covered on the Core NH formulary.
We developed this FAQ to help answer questions you may have about the Core NH 5-Tier formulary. Please contact your Harvard Pilgrim account executive if you have other questions or need more information.