As part of ongoing reviews of policies, Harvard Pilgrim recently made some changes to our commercial prior authorization policies for the medical drugs Temodar and Zoladex.
Harvard Pilgrim’s commercial prior authorization policy for the physician-administered injectable form of the drug Temodar outlines the approved indications and the criteria that must be met for coverage.
With the updates to the policy, refractory anaplastic astrocytoma is now an approved indication for the injectable form of Temodar. In addition, the medication is no longer covered for the following indications, based on the National Comprehensive Cancer Network’s compendia:
- Supratentorial primitive neuroectodermal tumor
- Metastatic dermatofibrosarcoma protuberans
Harvard Pilgrim has updated our commercial prior authorization policy for the medication Zoladex to allow for an increased dose for the palliative treatment of advanced breast cancer in pre-and perimenopausal women. These patients are no longer restricted to the 3.6 mg strength.
As a reminder, CVS Health–NovoLogix oversees Harvard Pilgrim’s prior authorization program for medical drugs. To request authorization for Temodar or Zoladex, please contact CVS Health–NovoLogix via phone (844-387-1435) or fax (844-851-0882).
For more information, please refer to the updated Temodar Medical Review Criteria and Zoladex Medical Review Criteria.