Harvard Pilgrim urges providers to consider our prior authorization criteria and the appropriate formulary before dispensing sample medications to our members.
Adhering to Harvard Pilgrim’s coverage verification processes before starting a member with samples of a particular medication helps maintain strong continuity of care. Prior to dispensing a medication sample, please be sure to locate the drug on our Prescription Drug List to verify that Harvard Pilgrim covers it, review whether it will require prior authorization, and if so, familiarize yourself with the prior authorization criteria to confirm that the member would be approved for the drug after sample is exhausted.
Note that the prior use of samples will not be considered in the evaluation of a member’s eligibility for medication coverage. One way to ensure seamless continuity of care is to submit a prior authorization request before administering medication samples to determine in advance if that medication will be approved to treat the patient.