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

August 2014

Reminder: Prior Authorization and Quantity Limits for Testosterone Therapy 

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.

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Trainings Available for Connecticut Providers

Join Us for a Half-Day Mindfulness Conference in November

Reminder: Symposium on Emotional Well-Being and Positive Mental Health


A Note on Genetic Testing from Michael Sherman, M.D, Chief Medical Officer

Prior Authorization Required for BRCA Testing

Reminder: Prior Authorization and Quantity Limits for Testosterone Therapy

Increase in Painkiller Prescriptions and Overdoses


Reminder: Coding for DME Reimbursement

Reminder for EFT Users with Clearinghouses

New Hampshire Health Protection Program Goes Live Aug. 15


Eric H. Schultz,
President and Chief Executive Officer

Richard Weisblatt PhD,
Senior Vice President, Provider Network

Annmarie Dadoly,

Kristin Edmonston,
Production Coordinator