Effective for dates of service beginning Nov. 1, 2018, Harvard Pilgrim has updated our prior authorization policy for Makena to also include coverage for the generic form of hydroxyprogesterone caproate. Makena and its generic version are indicated to reduce the risk of preterm birth in women with a singleton pregnancy who have a history of singleton spontaneous preterm birth.
The updated policy outlines the criteria that must be met for coverage of these medications. Please use HCPCS code J1729 (Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg) when billing for the generic version, and continue to use J1726 (Injection, hydroxyprogesterone caproate, [Makena], 10 mg) for brand-name Makena.
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 Makena 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.