Harvard Pilgrim covers the medications Hemlibra (for the treatment of hemophilia A) and Luxturna (for the treatment of biallelic RPE65 mutation-associated retinal dystrophy) for our commercial members. Coverage of these drugs requires prior authorization, which is managed by CVS Health—NovoLogix.
Following a recent coding update, there are now two new HCPCS codes that are more appropriate for billing Hemlibra and Luxturna. Going forward, please use these codes when submitting claims for the use of the respective drugs:
- Hemlibra: Q9995 – Injection, emicizumab-kxwh, 0.5 mg
- Luxturna: C9032 – Injection, voretigene neparvovec-rzyl, 1 billion vector genome
For complete information, please refer to our Hemlibra Medical Review Criteria and Luxturna Medical Review Criteria and the associated prior authorization request forms, which you can find on the Medical Drug Prior Authorization page
in the Provider section of Harvard Pilgrim’s website.