Harvard Pilgrim Health Care Home
  Learn more.
  Sign up for HPHConnect.
Medical Management
For Your Patient
News Center
Network Matters
Newsletter Archives
Newsletter Registration
Office Support
Provider Manual
Medicare Advantage
Research & Teaching
Resources & Links
Print    Text Size

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

October 2013

Prior Authorization for Cinryze 

For dates of service beginning January 1, 2014, Harvard Pilgrim will be requiring prior authorization for the medication Cinryze (C1 esterase inhibitor). Cinryze is an injectable drug used to prevent pain and swelling in people with hereditary angioedema (HAE), an immune disorder that causes rapid swelling of the hands, feet, face, intestinal tract, and windpipe.

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 Prior Authorization Medical Review Criteria for Cinryze.

When requesting prior authorization via HPHConnect for providers, please go to the “Outpatient” tab and select “Pharmacy” in the “Requested Service” drop down menu to ensure that the request is processed properly.

Cinryze is also available through Harvard Pilgrim’s specialty pharmacy program. If you choose to obtain Cinryze from the specialty pharmacy program, the prior authorization request must be submitted to MedImpact, rather than Harvard Pilgrim. For more information on this process, please visit the Pharmacy prior authorization page.

Email this article to a colleague   

Receive Network Matters by e-mail

Network Matters Archives

Download printer-friendly version


Medicare Advantage StrideSM (HMO) Plans Offered in January

Harvard Pilgrim #1 for 10th Year in a Row

Pediatric Dental and Vision Coverage

Harvard Pilgrim Collaborates on New Hampshire Medicaid Program


Specialty Pharmacy Name Change

Prior Authorization for Cinryze

P&T Committee Updates

Fecal Bacteriotherapy Now Covered with Prior Authorization

HEDIS Spotlight: Follow-up Care for Children Taking ADHD Medication

Recognizing Social Phobia in the Primary Care Setting

Reminder: Synagis for the Upcoming RSV Season


C Codes Now Accepted

Outpatient Fee Schedule Updates

2014 CPT and HCPCS codes

Change in Proration for Inpatient Stays with Partial Eligibility

Reminder: HPHConnect Account Revalidation


Eric H. Schultz,
President and Chief Executive Officer

Richard Weisblatt PhD,
Senior Vice President, Provider Network

Annmarie Dadoly,

Kristin Edmonston,
Production Coordinator