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

August 2018

Rebinyn and Durolane to be Covered with Prior Authorization

As you are aware, prior authorizations are required for select medical drugs for Harvard Pilgrim’s commercial members through CVS Health–NovoLogix. Several coagulation factor IX drugs for hemophilia B and hyaluronate preparations for osteoarthritis of the knee are currently managed via this prior authorization management program.

For dates of service beginning Oct. 1, 2018, Harvard Pilgrim will begin covering two additional drugs that fall under those categories — Rebinyn and Durolane, which were approved by the FDA last year — with prior authorization through CVS Health—NovoLogix.

The following CPT codes will be added to the list of codes associated with the commercial medical drug prior authorization program:

  • C9468 – Injection, Factor IX (antihemophilic factor, recombinant), glycopegylated, Rebinyn, 1 IU
  • C9465 – Hyaluronan or derivative, Durolane, for intra-articular injection, per dose

For complete information, please refer to the Rebinyn Medical Review Criteria and Durolane 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.

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Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator