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

January 2017

Reminder: Lidocaine Patch Coverage for Medicare Advantage Members

As a reminder, Harvard Pilgrim covers lidocaine patches for our StrideSM (HMO) Medicare Advantage members, with prior authorization, for the treatment of FDA-approved or medically accepted indications. The Centers for Medicare and Medicaid Services (CMS) expects Medicare Part D prescription drug benefit plans, such as Harvard Pilgrim’s Stride plans, to be responsible for implementing measures that ensure that Part D drugs are prescribed and utilized according to CMS regulations.

Use of lidocaine patches must be for an FDA-approved indication or supported by citations in one or more of the following compendia to qualify for coverage under Part D:

  • American Hospital Formulary Service Drug Information (AHSF-DI)
  • DRUGDEX Information System
  • United States Pharmacopeia-Drug Information (or its successor publications)

Harvard Pilgrim covers the use of lidocaine patches for the following indications only:

  • Relief of pain associated with post-herpetic neuralgia
  • Diabetic neuropathy
  • Burn pain
  • Cancer pain
  • Topical local anesthesia
In keeping with CMS regulations, lidocaine patches are not covered for any indications not listed above (for example, chronic lower back pain) under Harvard Pilgrim’s Stride (HMO) Medicare Advantage plans.

To request prior authorization for the coverage of lidocaine patches, please fill out our Medicare Prescription Drug Determination Request Form and send it by fax to 888-807-6643, or by mail to:

MedImpact Healthcare Systems, Inc.
Attn: Prior Authorization Department
10181 Scripps Gateway Court
San Diego, CA 92131

For more information, refer to Harvard Pilgrim’s Prior Authorization Criteria for Medicare Advantage plans.

    Email this article to a colleague   

    Network Matters Archives

    Download printer-friendly version


    Website Redesign: Navigating to the Provider Website


    Update to Eylea Medical Policy

    Reminder: Lidocaine Patch Coverage for Medicare Advantage Members

    Pharmacy & Therapeutics Committee Updates

    Specialty Pharmacy Program Update

    Behavioral Health and Loneliness in Older Adults


    2017 Fee Schedule Updates


    Eric H. Schultz,
    President and Chief Executive Officer

    Robert Farias,
    Vice President, Network Services

    Annmarie Dadoly,

    Joseph O'Riordan,

    Kristin Edmonston,
    Production Coordinator