In light of the nation’s ongoing opioid addiction crisis, Harvard Pilgrim would like to remind providers of our coverage for generic naloxone and Narcan nasal spray, both of which are available to our members with no copayment requirements. These medications, known as opioid antagonists, are used to counter the effects of opioid overdose.
Harvard Pilgrim supports the prescribing of opioid antagonists to patients who are considered at high risk for opioid overdose. We encourage providers to issue accompanying prescriptions for appropriate naloxone products to patients who are prescribed opioids and display factors that increase the risk of overdose, such as a history of substance abuse.
Generic naloxone coverage
Harvard Pilgrim covers generic naloxone syringes and vials at no member cost share on our Premium and Value formularies, with a quantity limit of four units per 30 days. Naloxone syringes are most commonly used with an atomizer attachment for nasal administration.
Narcan nasal spray
Harvard Pilgrim also covers Narcan (naloxone hydrochloride) nasal spray with no member cost share on our Premium and Value formularies. The efficiency and ease of administration offered by Narcan nasal spray present a tremendous advantage in the emergency treatment of known or suspected overdose. Narcan nasal spray is covered with a quantity limit of two packages (four inhalers) per 30 days. It is intended for immediate administration as emergency therapy.
If you would like more information about Harvard Pilgrim pharmacy programs and medication policies, please visit our Pharmacy website.
How Optum/UBH can help with substance abuse services Optum/UBH (Harvard Pilgrim’s behavioral health partner) can help with referrals for outpatient behavioral health services by locating in-network services — including chemical dependency services and providers of specialized treatments — and locating practitioners to provide initial screening evaluations and, if needed, subsequent psychological or neuropsychological testing referrals.
To refer a patient for behavioral health services, call Optum at 888-777-4742. To speak with an Optum clinician to discuss treatment options, call the Optum Physicians Consultation service at 800-292-2922.