In January, the Food and Drug Administration approved the radioactive drug Lutathera for the treatment of cancer that affects the pancreas or gastrointestinal tract, called gastroenteropancreatic neuroendocrine tumors (GEP-NETs). This medical drug will fall under Harvard Pilgrim’s existing medical drug prior authorization program.
Effective immediately, Harvard Pilgrim will provide coverage for commercial members for Lutathera with prior authorization from CVS Health—NovoLogix for the treatment of somatostatin receptor-positive GEP-NETs.
To request authorization for Lutathera, please contact CVS Health–NovoLogix via phone (844-387-1435) or fax (844-851-0882). For complete information, please refer to our new Lutathera Medical Review Criteria and the associated prior authorization request form.