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

January 2019

TriVisc and Jivi Now 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 antihemophilic Factor VIII medications for hemophilia A and hyaluronate preparations for osteoarthritis of the knee are currently managed via this prior authorization management program. Harvard Pilgrim is now covering two additional drugs that fall under those categories — Jivi (antihemophilic factor (recombinant), pegylated-aucl for injection) and TriVisc (sodium hyaluronate) — 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:

  • J7199 – Hemophilia clotting factor, not otherwise classified
  • J3490 – Unclassified drugs
  • J3590 – Unclassified biologics

For complete information, please refer to the Factor VIII Concentrates Medical Review Criteria and TriVisc 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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