Harvard Pilgrim requires prior authorization for the new medications Cutaquig and Libtayo for our commercial members.
Cutaquig, which was approved by the FDA in December 2018, is a subcutaneous immune globulin product used to treat primary humoral immunodeficiency in adults. Libtayo was approved in September 2018 and is used to treat patients with metastatic cutaneous squamous cell carcinoma (CSCC) or locally advanced CSCC who are not candidates for curative surgery or curative radiation.
For both Cutaquig and Libtayo, bill the HCPCS code J3590 (unclassified biologics). To request authorization, please contact CVS Health–NovoLogix via phone (844-387-1435) or fax (844-851-0882).
For complete criteria, please refer to our Subcutaneous Immune Globulin (SCIG) prior authorization policy
and Libtayo prior authorization policy.