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

January 2020

Updates to Yervoy Medicare Advantage Medical Policy


Harvard Pilgrim has updated our StrideSM (HMO) Medicare Advantage prior authorization policy for the medication Yervoy (J9228). Changes include:

  • Adding cutaneous melanoma, colorectal cancer, and renal cell carcinoma as covered indications and specifying their respective coverage criteria and dosing information per FDA labeling
  • Adding criteria for compendial therapy
  • Removing stage II melanoma from covered indications
  • For coverage of Yervoy for unresectable/metastatic melanoma:
    • Requiring that the member be 12 years of age or older
    • No longer requiring medical record documentation to confirm Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2

To request authorization, please complete the Medicare Advantage Prior Authorization Request form and fax it to 866-874-0857 or call the Medicare Advantage Provider Service Center at 888-609-0692. For more information, please refer to the updated StrideSM (HMO) Medicare Advantage Yervoy Medical Policy.

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