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

March 2014

Updated Medical Review Criteria for H.P. Acthar Gel 

Effective May 15, 2014, Harvard Pilgrim is updating its medical review criteria for the medication H.P. Acthar Gel to ensure that use is reasonable and necessary, clinically appropriate, and supported by evidence-based literature.

Harvard Pilgrim will continue to require a prior authorization for H.P. Acthar Gel. Under the new policy, however, Harvard Pilgrim will limit the conditions for which H.P. Acthar Gel is covered to infantile spasms (West Syndrome) and steroid-responsive multiple sclerosis, when specific medical criteria are met. 

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 H.P. Acthar Gel.

Acthar is also available through Harvard Pilgrim’s specialty pharmacy program with Accredo. If you choose to obtain H.P. Acthar Gel from the specialty pharmacy program, the prior authorization request must be submitted to MedImpact, rather than Harvard Pilgrim. For more information, please visit the Pharmacy program’s prior authorization page.

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Eric H. Schultz,
President and Chief Executive Officer

Richard Weisblatt PhD,
Senior Vice President, Provider Network

Annmarie Dadoly,

Kristin Edmonston,
Production Coordinator