Harvard Pilgrim Health Care Home
  HPHConnect
 
  Learn more.
  Sign up for HPHConnect.
Medical Management
E-Transactions
HPHConnect
Pharmacy
For Your Patient
News Center
Network Matters
Newsletter Archives
Newsletter Registration
Newsroom
Office Support
Products
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

Harvard Pilgrim Preferred Insulin Products on the Value Formulary


As we noted in an earlier Network Matters article, effective October 1, 2016, Harvard Pilgrim designated Humulin (short- and intermediate-acting) and Humalog (rapid-acting) as our preferred insulin products on the Premium formulary. As of January 1, 2017, this same change will take effect on the Value formulary.

If you have patients with diabetes who are prescribed NovoLog or Novolin rapid-, short-, or intermediate-acting insulins, please be aware that they will have to pay a higher copayment for these insulins as of the January 1 effective date. While the Humulin and Humalog products will remain at their current tiers, their equivalent NovoLog and Novolin products will be moving to Tier 3 on the 3-Tier and 4-Tier Value formularies, and Tier 4 on the 5-Tier Value formulary. Coverage of long-acting insulins will remain unchanged.

Additionally, as of January 1, 2017, Harvard Pilgrim will require prior authorization for the coverage of NovoLog and Novolin, rapid, short-, or intermediate-acting insulin products on the Value formulary. Harvard Pilgrim’s clinical review criteria detail the requirements that must be met in order to obtain prior authorization for these products.

Harvard Pilgrim will require prior authorization for the following NovoLog and Novolin insulin products on the Value formulary:

  • Novolin 70-30 Vial
  • Novolin N
  • Novolin R
  • NovoLog
  • NovoLog FlexPen
  • NovoLog Mix 70/30

The comparable Humalog and Humulin insulin products, listed below, will not require a prior authorization and will be covered at the preferred brand tier:

  • Humulin N/KwikPen
  • Humulin 70-30/KwikPen
  • Humalog Mix 50/50 KwikPen
  • Humulin R/KwikPen
  • Humalog/KwikPen
  • Humalog Mix 75/25 KwikPen

For more information, refer to the Pharmacy section of Harvard Pilgrim’s provider website.

Email this article to a colleague   


Network Matters Archives

Download printer-friendly version

HPHCURRENT EVENTS

New Opioid Safety Edits for Medicare and Commercial Plans

CLINICIAN CORNER

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

OFFICE ASSISTANT

Keep Panel Status and Demographic Information Up to Date

PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator