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.