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

January 2020

Prior Authorizations for Xiaflex and Miacalcin


Beginning March 1, 2020, Harvard Pilgrim will require prior authorization for the medications Xiaflex (J0775) and Miacalcin (J0630).

Under these new policies, when clinical criteria is met Xiaflex will be covered for the treatment of Dupuytren’s contracture and Peyronie’s disease, and Miacalcin will be covered for conditions including Paget’s disease of bone, hypercalcemia, and postmenopausal osteoporosis, as well as the management of pain following an osteoporotic vertebral fracture.

For complete information, please refer to Harvard Pilgrim’s new Xiaflex Medical Policy and Miacalcin Medical Policy. To request authorization, contact CVS Health—NovoLogix via phone (844-387-1435) or fax (844-851-0882).

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