Harvard Pilgrim has updated our prior authorization criteria for our commercial members for the medication Xgeva, which is used to protect the bones of patients with multiple myeloma and in patients with bone metastases from solid tumors.
For the use of Xgeva to treat bone metastases from prostate cancer, Harvard Pilgrim’s criteria no longer require that the patient has castration-recurrent prostate cancer. Coverage for Xgeva will continue to require prior authorization.
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 Xgeva, please contact CVS Health–NovoLogix via phone (844-387-1435) or fax (844-851-0882).
For complete information, please refer to our new Xgeva Medical Review Criteria and the associated prior authorization request form.