Harvard Pilgrim Health Care Home
  Learn more.
  Sign up for HPHConnect.
Medical Management
For Your Patient
News Center
Network Matters
Newsletter Archives
Newsletter Registration
Office Support
Provider Manual
Medicare Advantage
Research & Teaching
Resources & Links
Print    Text Size

Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

December 2016

Updates to Prior Authorization Policy for Ilaris

Harvard Pilgrim is updating our prior authorization policy for the medication Ilaris. Harvard Pilgrim covers the use of Ilaris when it is medically necessary to treat certain conditions characterized by periodic attacks of fever and inflammation, as well as severe muscle and joint pain, among other symptoms.

In September 2016, the FDA approved the use of Ilaris for additional indications. In keeping with this, effective immediately, Harvard Pilgrim will cover Ilaris for the following additional indications:

  • Tumor necrosis factor receptor associated periodic syndrome (TRAPS)
  • Hyperimmunoglobulin D syndrome (HIDS)/Mevalonate Kinase Deficiency (MKD)
  • Familial Mediterranean Fever (FMF)

For complete information, please refer to Harvard Pilgrim’s updated Ilaris Medical Review Criteria. When requesting authorization, providers in Massachusetts should complete the Massachusetts Standard Form for Medication Prior Authorization Requests, including any supplementary information that may be useful in the “Additional information pertinent to this request” section, and fax it to MedImpact Healthcare Systems at 888-807-6643. Providers in all other states should complete the Ilaris Medication Request Form and fax it to MedImpact Healthcare Systems at 888-807-6643.

    Email this article to a colleague   

    Network Matters Archives

    Download printer-friendly version


    New Opioid Safety Edits for Medicare and Commercial Plans


    Update: New Coding for CT Screening for Lung Cancer

    Updates to Reimbursement for Moderate Sedation Services

    Harvard Pilgrim Will Cover Screening 3D Mammography in Connecticut

    Massachusetts Standard Form for Medication Prior Authorization Requests

    Updates to Prior Authorization Policy for Ilaris

    Medicare Prescriber Enrollment Deadline Updated

    Harvard Pilgrim Preferred Insulin Products on the Value Formulary

    Depression Screening and Potential Side Effects of Antidepressants


    Keep Panel Status and Demographic Information Up to Date


    Eric H. Schultz,
    President and Chief Executive Officer

    Robert Farias,
    Vice President, Network Services

    Annmarie Dadoly,

    Joseph O'Riordan,

    Kristin Edmonston,
    Production Coordinator