Harvard Pilgrim only covers compounded medications that are medically necessary
for your adult patient's care.
How Do I Request Coverage for a Compounded Medication?
You may submit a Compound
Exceptions Request Form for coverage of a compounded medication on behalf
of your patient. We will make a decision on whether a compounded medication
will be covered within 48 hours of receiving the request, based on whether use
of a compounded medication is medically necessary.
Completed Medication Request forms should be submitted to:
MedImpact Healthcare Systems
What Happens if my Request is Denied by Harvard Pilgrim?
If Harvard Pilgrim denies your request for coverage of a compounded medication,
your patient may file an appeal. We provide a detailed description of member
appeal rights in your patient's Benefit Handbook. Your patient may also call
Harvard Pilgrim Member Services for information on how to file an appeal.
If you have any questions about Harvard Pilgrim's coverage for compounded medications,
please call Harvard Pilgrim Pharmacy Services at (617) 509-9060.