Harvard Pilgrim requires prior authorization for certain medications. The Medication Prior Authorization Program helps to ensure appropriate use of medications. We do this so that our members can have continued access to certain costly medications.
How to obtain prior authorization
Prior authorization requests are reviewed by Harvard Pilgrim’s pharmacy benefits manager, MedImpact. To obtain coverage for drugs requiring prior authorization, prescribers must fax a completed Medication Request Form (MRF) to MedImpact at (858) 790-7100.
Providers can obtain the forms online or by calling MedImpact’s Customer Service at (800) 788-2949.
All requests for prior authorization are processed and a determination is rendered and communicated to both the member and the prescriber within two business days of receipt of all necessary information. If additional information is required, your provider will be notified regarding the specific information needed within one business day of receipt of the request. If we do not receive the additional information that is necessary to make a determination, your request will be denied.
To find out if your medication requires prior authorization, go to your prescription plan and search for your drug on the drug tier look-up. To learn more about the Medication Prior Authorization Program, members can call Harvard Pilgrim Member Services at (888) 333-4742. For TTY service, dial 711.