Harvard Pilgrim Health Care Home
  HPHConnect
 
  Learn more.
  Sign up for HPHConnect.
Medical Management
E-Transactions
HPHConnect
Pharmacy
For Your Patient
News Center
Network Matters
Newsletter Archives
Newsletter Registration
Newsroom
Office Support
Products
Provider Manual
Medicare Advantage
Research & Teaching
Resources & Links
 
Print    Text Size

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

July 2018

Temodar and Zoladex Prior Authorization Updates


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.

Temodar

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

Zoladex

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.

More information

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.

Email this article to a colleague   


Network Matters Archives

Download printer-friendly version

HPHCURRENT EVENTS

Medicare Advantage: New Payment Policy Regarding Inpatient Admissions

New Online Behavioral Health Pilot Program

CT Pilot Program: GlucoseZone for Personalized Diabetes Management

CLINICIAN CORNER

Update to Harvard Pilgrim’s Gynecomastia Medical Review Criteria

Temodar and Zoladex Prior Authorization Updates

Coverage of Newly Approved Medications With Prior Authorization

Suicide Prevention Resources

OFFICE ASSISTANT

Payment Policy Updates: SNF and Rehabilitation Facility/LTAC

Hierarchical Condition Categories Coding Reminders

PUBLICATION INFORMATION

Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator