For dates of service beginning October 15, 2013, Harvard Pilgrim is requiring prior authorization for the following medications: H.P. Acthar Gel, Aloxi, Emend, Anzemet, Xolair, and Yervoy. Prior authorization is necessary to ensure that use is reasonable and necessary, clinically appropriate, and supported by evidence-based literature.
To obtain a prior authorization, providers must submit the required written information and meet the criteria as specified in the Prior Authorization Medical Review Criteria for Aloxi, Anzemet, Emend, H.P. Acthar Gel, Xolair, or Yervoy.
When requesting prior authorization via HPHConnect for providers, please select the “Outpatient” tab and select “Pharmacy” in the “Requested Service” drop down menu to ensure that the request is processed properly.
Xolair and Acthar are also available through Harvard Pilgrim’s specialty pharmacy program, with ICore supplying Xolair and Curascript supplying Acthar. If you choose to obtain Xolair or Acthar from the specialty pharmacy program, the prior authorization request must be submitted to MedImpact, rather than Harvard Pilgrim. For more information, please visit the Pharmacy program’s prior authorization page.