Harvard Pilgrim Health Care Home
  Learn more.
  Sign up for HPHConnect.
Medical Management
For Your Patient
News Center
Network Matters
Newsletter Archives
Newsletter Registration
Office Support
Provider Manual
Medicare Advantage
Research & Teaching
Resources & Links
Print    Text Size

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

March 2016

Verify Coverage Before Dispensing Medication Samples

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.

Email this article to a colleague   

Network Matters Archives

Download printer-friendly version


Medicare Prescriber Enrollment Deadline Updated


Reducing Preventable Readmissions in Medicare Advantage Population

Clinical Policy and Prior Authorization Updates

Update to Formulary Exception Request Process

Verify Coverage Before Dispensing Medication Samples

Massachusetts Providers: Enroll in Online Prescription Monitoring Program

Complex Case Management Services

Disease Management Programs that Reinforce Physician Treatment Plans

Self-Harm and Alcohol Abuse Risks After Bariatric Surgery


Reminder: Keep Panel Status Up to Date


Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator