As we noted in the May issue of Network Matters, Harvard Pilgrim requires prior authorization and has set quantity limits on testosterone therapy for all members age 18 and older.
This policy was phased in, with an effective date of May 15, 2014 for members beginning testosterone therapy and Sept. 1, 2014 for members currently receiving testosterone therapy. Please refer to our updated Testosterone Clinical Criteria for details on quantity limits, prior authorization requirements, and renewal criteria.
In addition, beginning Sept. 1, 2014, injectable testosterone (testosterone cypionate, testosterone enanthate) will be covered under the standard prescription drug benefit, and the member’s pharmacy cost share will apply.
To obtain prior authorization, please complete the appropriate Medication Request Form and fax it back to MedImpact Healthcare Systems at 888-807-6643.