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

November 2018

Updates to Rituxan Medical Review Criteria


Harvard Pilgrim has updated our commercial medical review criteria for the medication Rituxan, which is covered with prior authorization for the medically necessary treatment of certain conditions in patients 18 and older. It is no longer a requirement that a member have a hepatitis B screening with serologic assays documented in his or her chart or medical record to be covered for Rituxan. In addition, the drug is now covered for the following added indications, when all the necessary criteria on the policy are met:

  • Moderate to severe pemphigus vulgaris
  • Neuromyelitis optica (Devic disease)
  • Refractory polymyositis or dermatomyositis (forms of idiopathic inflammatory myopathy)

As a reminder, prior authorization is required for Rituxan. To request authorization, please contact CVS Health–NovoLogix via phone (844-387-1435) or fax (844-851-0882).

For more information, refer to the updated Rituxan Medical Review Criteria and the appropriate prior authorization form on Harvard Pilgrim’s Medical Drug Prior Authorization page. Also, please keep in mind that for any given drug, Harvard Pilgrim’s Maximum Units Per Day Payment Policy may apply.

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