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

November 2018

Updates on Medical Drugs Obtained Through Specialty Pharmacy

As you may know, Harvard Pilgrim Health Care makes select medical drugs available through both the buy and bill process and specialty pharmacy to allow members and providers greater choice and convenience. We will be making a few changes next year to ensure that member cost share is applied uniformly, no matter which method is used to obtain and bill for medical drugs.

After a review, we determined that, depending on which billing method was used, some commercial members were being charged an appropriate cost share for their medical drugs according to the terms of their policy and others were not. As of July 1, 2019, any commercial member receiving one of these drugs will be responsible for appropriate cost-sharing.

We are notifying members who take these medications of this change starting in November to allow them adequate time to plan for medical expenses and any reimbursement accounts. If any of your Harvard Pilgrim patients have questions about this change, please direct them to the member services phone number on the back of their Harvard Pilgrim ID card.

The change for providers is minimal. If you obtain medical drugs through buy and bill, the process remains the same as it is today. Likewise, it is also unchanged for medications you obtain through the specialty pharmacy that don’t require prior authorization. However, if you would like to utilize the specialty pharmacy for medications on the attached list that do require prior authorization, beginning on July 1, 2019, please contact CVS Health-NovoLogix for prior authorization, rather than MedImpact.

We will be running a follow-up article next May as a reminder about this change.

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Robert Farias,
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Annmarie Dadoly,

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Kristin Edmonston,
Production Coordinator