Effective immediately, Harvard Pilgrim is now covering the medication Rexulti with prior authorization. In July, the U.S. Food and Drug Administration (FDA) approved Rexulti, a drug used to treat adults with schizophrenia and as an add-on treatment to an antidepressant medication to treat adults with major depressive disorder. Rexulti 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 Premium formularies).
Harvard Pilgrim is requiring prior authorization to ensure the cost-effective and appropriate use of Rexulti. Harvard Pilgrim’s Rexulti Clinical Review Criteria detail the requirements that must be met in order to obtain prior authorization. To request prior authorization, please complete the Rexulti 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.