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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.

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PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator