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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

December 2017

Keytruda and Opdivo Prior Authorization Policies Updated


Harvard Pilgrim has updated our prior authorization policies for the cancer medications Keytruda and Opdivo to include additional covered indications and updated criteria, effective immediately.

Keytruda

Harvard Pilgrim now covers Keytruda for the treatment of the following additional indications, when all applicable criteria are met:

  • Malignant pleural mesothelioma
  • Merkel cell carcinoma
  • Gastric carcinoma

In addition, prior treatment with a fluoropyrimidine, oxaliplatin, and irinotecan is no longer required for Keytruda to be covered for the treatment of microsatellite instability-high colorectal cancer.

Opdivo

Harvard Pilgrim now reimburses the use of Opdivo for the treatment of the following additional indications, when all applicable criteria are met:

  • Microsatellite instability-high colorectal cancer
  • Malignant pleural mesothelioma
  • Hepatocellular carcinoma

Requesting prior authorization

As a reminder, CVS Health–NovoLogix oversees our prior authorization program for medical drugs to optimize treatment outcomes and promote the safe and cost-effective use of these medications. To request authorization for Keytruda and Opdivo, please contact CVS Health–NovoLogix via phone (844-387-1435) or fax (844-851-0882).

For complete information, please refer to our updated Keytruda Medical Review Criteria and Opdivo Medical Review Criteria.

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