Harvard Pilgrim now covers the medication Retacrit for members of our commercial plans. Retacrit is an epoetin alfa that was approved by the FDA in May 2018 as a biosimilar to Epogen and Procrit for the treatment of anemia due to: chronic kidney disease in patients on dialysis and not on dialysis; the use of zidovudine in patients with HIV infection; and the effects of concomitant myelosuppressive chemotherapy. It is also approved to reduce the need for allogeneic red blood cell transfusions in patients undergoing elective, noncardiac, nonvascular surgery.
As with Epogen and Procrit, the use of Retacrit requires prior authorization. You can find the complete list of covered indications and coverage criteria on Harvard Pilgrim’s updated Epogen, Procrit, and Retacrit prior authorization policy.
The following codes have been added for coverage, and require prior authorization:
- Q5105 - Injection, epoetin alfa, biosimilar, (Retacrit) (for ESRD on dialysis), 100 units
- Q5106 - Injection, epoetin alfa, biosimilar, (Retacrit) (for non-ESRD use), 1000 units
To request authorization, please contact CVS Health–NovoLogix via phone (844-387-1435) or fax (844-851-0882). For more information, please refer to Harvard Pilgrim’s Epogen, Procrit, and Retacrit Medical Review Criteria and prior authorization request form.