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 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 Mix 75/25 KwikPen
For more information, refer to the Pharmacy section of Harvard Pilgrim’s provider website.