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.