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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

June 2018

Coverage of Higher Dosage of Lupron Depot for Breast Cancer

Effective immediately, Harvard Pilgrim will provide reimbursement for a higher maximum dosage of Lupron Depot for commercial members being treated for breast cancer. Reimbursement will be provided for up to 7.5 milligrams of Lupron monthly, or 22.5 milligrams for 3 months, administered as a single injection for patients with breast cancer.

For all other indications, the allowed maximum dosage has not been changed. Prior authorization is required for coverage of Lupron Depot through CVS Health—NovoLogix, which oversees our prior authorization program for medical drugs. To request authorization for Lupron Depot, please contact CVS Health–NovoLogix via phone (844-387-1435) or fax (844-851-0882). For complete information, please refer to our updated Lupron Depot Medical Review Criteria and the associated prior authorization request form.

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New Program Rewards Medicare Advantage Patients for Healthy Behaviors

GIC Product Updates Effective July 1

Introducing New Hampshire POS Open Access Plans

Harvard Pilgrim Grant Announcements


Coverage of Higher Dosage of Lupron Depot for Breast Cancer

Benign Prostatic Hypertrophy Medical Policy Updates

Cryotherapy for Prostate Cancer Requires Prior Authorization

Coverage of Fecal Calprotectin Testing

Lutathera Covered with Prior Authorization

Updates to TMJ Prior Authorization Policy

Prior Authorization No Longer Required for Cologuard Test

Follow-up WebEx on Reducing Avoidable Hospital Admissions


Negative Balance and Refund Process Enhancements

Enhanced Processes and Communication with Providers

Keep Panel Status and Demographic Information Up to Date

Early Intervention Provider Fee Schedule Update

2018 Home Care Seasonal Flu Vaccine Fee Schedule

Documenting Deep Vein Thrombus and Pulmonary Embolism


Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator