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

New Prior Authorization Policy for Hemlibra

Harvard Pilgrim is covering the new-to-market drug Hemlibra for commercial members with prior authorization. The FDA approved Hemlibra (emicizumab-kxwh) in November 2017 to prevent or reduce the frequency of bleeding episodes in adult and pediatric patients with hemophilia A who have developed antibodies called Factor VIII (FVIII) inhibitors.

Effective immediately, Harvard Pilgrim will cover Hemlibra with prior authorization for the treatment of hemophilia A when laboratory testing confirms that the patient has a history of high-inhibitor titer (i.e., = 5 Bethesda units per milliliter). Initial authorizations will be for 6 months, and may be expanded to 12 months for patients who meet all initial authorization criteria and achieve and maintain reduction in the frequency of bleeding episodes.

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 Hemlibra, please contact CVS Health–NovoLogix via phone (844-387-1435) or fax (844-851-0882). For complete information, please refer to our new Hemlibra Medical Review Criteria and the associated prior authorization request form

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