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Commercial Medical/Clinical Policies

Harvard Pilgrim’s medical/clinical policies for commercial members are available below. This list includes prior authorization criteria and policies in which prior authorization is not required; policies requiring prior authorization are designated with the PA notation below.

Harvard uses evidence-based criteria to make fair, impartial, and consistent decisions that facilitate the appropriate use of select services. All criteria are reviewed/updated annually.

View the Prior Authorization Medical Review Forms

Provide Feedback on Clinical Policies

Medical Drug Claim Editing List (Max Dose)