Harvard Pilgrim’s Specialty Pharmacy Program has added the following medications:
|Indicated for the treatment of chorea associated with Huntington’s disease.
||Limited Distribution Drug: Cardinal Health Specialty Pharmacy|
A corticosteroid indicated for the treatment of Duchenne
muscular dystrophy (DMD) in patients 5 years of age and older.
||Limited Distribution Drug: U.S. Bioservices|
To request prior authorization for Austedo or Emflaza, providers in Massachusetts should use the Massachusetts Standard Form for Medication Prior Authorization Requests. Providers in all other states should use the drug-specific Medication Request Forms, which are located in the “Pharmacy” section of our Provider website, along with the clinical coverage criteria. Completed forms should be faxed to MedImpact Healthcare Systems at 858-790-7100.