Harvard Pilgrim has updated its Prior Authorization Medical Review Criteria for the medications Aloxi (palonosetron HCI injection), Anzemet (dolasetron mesylate), and Emend (fosaprepitant dimeglumine), which are used for treatment of nausea and vomiting. Effective March 14, 2014, all initial authorizations for ongoing treatment are limited to a maximum of six months.
Prior authorization is necessary to ensure that use of these medications 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, or Emend. When requesting authorization for these medications, please complete Harvard Pilgrim’s Medical Benefit Drugs Prior Authorization Request form and fax it to us at 800-232-0816.
For more information, refer to the Aloxi, Anzemet, and Emend Prior Authorization Medical Review Criteria.