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

April 2018

Harvard Pilgrim Adding Coverage for Newly Approved Medications

Effective for dates of service beginning April 1, 2018, Harvard Pilgrim has added coverage for our commercial members for the following medical drugs, which were recently approved by the FDA:

  • Fasenra – for the add-on maintenance treatment of patients with severe asthma, ages 12 years and older, and with an eosinophilic phenotype
  • Kymriah – for the treatment of patients up to 25 years of age with B-cell precursor acute lymphoblastic leukemia that is refractory or in second or later relapse
  • Luxturna – for the treatment of biallelic RPE65 mutation-associated retinal dystrophy
  • Yescarta – for the treatment of adult patients with relapsed or refractory large B-cell lymphoma

These medications are covered with prior authorization when the criteria outlined in their respective policies have been met. 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 drugs. To request authorization for one of these medications, please contact CVS Health–NovoLogix via phone (844-387-1435) or fax (844-851-0882).

For complete information, please refer to our new commercial Fasenra Medical Review Criteria, Kymriah Medical Review Criteria, Luxturna Medical Policy, and Yescarta Medical Review Criteria. Our Medical Drug Prior Authorization webpage includes these policies and the associated prior authorization request forms.

Email this article to a colleague   

Network Matters Archives

Download printer-friendly version


Reminder: Medical Drugs & Buy-and-Bill or Specialty Pharmacy


Cochlear Implants to Require Prior Authorization

Update to Bariatric Surgeries Prior Authorization Policy

New Bunionectomy Medical Review Criteria

Harvard Pilgrim Adding Coverage for Newly Approved Medications

Tips for Efficient Pharmacy Prior Authorization Process

Complex Case Management Services

Disease Management Programs Reinforce Physician Treatment Plans

Updates to Medical Policies and Prior Authorization Criteria

Policy Update: Replacement of the First Metatarsophalangeal Joint

Updates to Implantable Neurostimulators Medical Review Criteria

Corneal Collagen Cross-Linking Now Covered

New Prior Authorization Policy for Hemlibra

New Prior Authorization Policy for Imfinzi

Substance Use Disorder: Treatment and Helpful Resources

P&T Committee Meeting Update


Payment Policy Updates: DME and Orthotic and Prosthetic Devices

Medical Records: Common Issues and Quick Fixes


Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator