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

March 2015

Prior Authorization Required for Cosentyx 


Effective immediately, Harvard Pilgrim is now covering the medication Cosentyx with prior authorization on the Premium formularies. Cosentyx is a newly-approved IL-17A antagonist indicated for the treatment of moderate to severe plaque psoriasis.

Cosentyx will be covered on the Premium formularies only, at the highest tier (i.e. Tier 3 on the 3-Tier and Tier 4 on the 4-Tier). Harvard Pilgrim is requiring prior authorization to ensure the safe and appropriate use of Cosentyx. Harvard Pilgrim's Cosentyx Clinical Coverage Criteria detail the requirements that must be met in order to obtain prior authorization, including:

  • Patient is 18 years of age or older
  • Diagnosis of moderate to severe plaque psoriasis
  • Prescribed by (or in consultation with) a dermatologist
  • Patient has tried at least one course of systemic therapy for psoriasis including (but not limited to) acitretin, azathioprine, cyclosporine, hydroxyurea, methotrexate, mycophenolate mofetil, oral methoxsalen plus UVA light (PUVA), propylthiouracil, sulfasalazine, tacrolimus, or 6-thioguanine
  • Patient has tried and failed therapy with, or has a contraindication to, Humira or Enbrel
Approvals will be valid for 12 months. Harvard Pilgrim requires the following for a prior authorization to be renewed: the medication is prescribed by or in consultation with a dermatologist, the patient has been diagnosed with plaque psoriasis, and the patient's condition has improved while on therapy with Cosentyx.

To request prior authorization, please complete the Cosentyx Medication Request Form and fax it to MedImpact Healthcare Systems at 888-807-6643. For more information, please refer to the Pharmacy Section of Harvard Pilgrim's provider website.

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PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

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