Harvard Pilgrim will be covering several newly FDA-approved drugs for our commercial members. The following drugs will be covered with prior authorization for dates of service beginning Sept. 1, 2018:
- Rituxan Hycela – C9467, Injection, rituximab and hyaluronidase, 10 mg
- Mylotarg – J9203, Injection, gemtuzumab ozogamicin, 0.1 mg
- Besponsa – C9028 Injection, inotuzumab ozogamicin, 0.1 mg
- Tecentriq – J9022, Injection, atezolizumab, 10 mg
- Imlygic – J9325, Injection, talimogene laherparepvec, per 1 million plaque forming units
Please keep in mind that Harvard Pilgrim’s Maximum Units Per Day Payment Policy also applies.
CVS Health–NovoLogix oversees our prior authorization program for medical drugs. To request authorization for any of these medications, please contact CVS Health–NovoLogix via phone (844-387-1435) or fax (844-851-0882).
For more information, including the relevant policies and forms, refer to the Medical Drug Prior Authorization page in the Provider section of Harvard Pilgrim’s website.