Medication Request Forms (MRF) and Clinical Coverage Criteria
Medication Request Forms (MRF) Harvard Pilgrim’s prior authorization program ensures that our members are using the safest and most cost-effective medications for their condition. Completed forms should be faxed to MedImpact Healthcare Systems at 888-807-6643. If you have any questions regarding this process, please contact MedImpact's Customer Service at 800-788-2949.
Clinical Criteria Medications requiring prior authorization have clinical guidelines developed by licensed clinical pharmacists, which reflect the latest in evidence-based medicine and are used as a tool to promote quality, safety, and cost-effective pharmacotherapy. Harvard Pilgrim makes our clinical criteria available to physicians, as a reference. You can find our clinical criteria below, listed alphabetically by drug name.