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

P&T Committee Meeting Update

At the March 12, 2018 meeting, the Harvard Pilgrim Pharmacy & Therapeutics Committee reviewed three medications and decided the following:

P&T Committee Review and Decisions




Trelegy ellipta (fluticasone furoate, umeclidinium, and vilanterol)

Used to control and prevent symptoms caused by chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and/or emphysema.

• Premium and Value formularies: Moved from non-formulary to preferred brand tier 

• Medicare Advantage Formulary: Moved from non-formulary to preferred brand tier

Eucrisa (crisaborole)

Used for the topical treatment of mild-to-moderate eczema in patients ages two and older.

• Premium formulary: Continued coverage at the non-preferred brand tier with prior authorization 

• Value formulary: Moved to non-preferred brand tier with prior authorization

• Medicare Advantage formulary: Remains non-formulary

Dupixent (dupilumab)

Used to treat adults with moderate-to-severe eczema that is not adequately controlled with topical prescription therapies or who are unable to use topical therapies.

• Premium and Value formularies: Moved to preferred brand tier (specialty) with prior authorization 

• Medicare Advantage formulary: Continued coverage at Tier 5 specialty with prior authorization

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