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

May 2016

Coverage of Narcan Nasal Spray and Evzio

In the midst of the nation’s mounting opioid addiction crisis, Harvard Pilgrim supports the prescribing of opioid antagonists to patients who are considered at high risk for opioid overdose. We encourage providers to issue accompanying prescriptions for appropriate naloxone products to patients who are prescribed opioids and display factors that increase the risk of overdose, such as a history of substance abuse. Harvard Pilgrim holds that the efficiency and ease of administration offered by newly approved narcan nasal spray present a tremendous advantage in the emergency treatment of known or suspected overdose.

Positions of opioid authorities

Major opioid authorities and governing bodies maintain similar stances. The American Academy of Pain Management recently issued a statement with some recommendations for providers who prescribe opioids. The recommendations encouraged conducting comprehensive assessments of overdose risk in patients who are prescribed opioids, discussing appropriate use of opioid analgesics with them, and offering an accompanying prescription for an FDA-approved naloxone product.

In their 2016 Guideline for Prescribing Opioids for Chronic Pain, the Centers for Disease Control and Prevention also recommended issuing naloxone prescriptions when factors exist that increase the risk of overdose, such as history of overdose, history of substance use disorder, opioid doses higher than 50 MME per day, or concurrent benzodiazepine use.

Narcan nasal spray

In support of this shared outlook, effective immediately, Harvard Pilgrim is now covering narcan (naloxone hydrochloride) nasal spray with no member cost share on our Premium and Value formularies. Narcan nasal spray is an opioid antagonist used for the emergency treatment of known or suspected opioid overdose.

Narcan nasal spray will be covered with a quantity limit of one package (two inhalers) per fill, and two packages (four inhalers) per 30 days. It is intended for immediate administration as emergency therapy. Harvard Pilgrim encourages providers who prescribe opioids to patients considered at-risk for overdose to also consider supplying those patients with a concurrent prescription for narcan nasal spray to be used in case of emergency.

Prior authorization now required for Evzio

Additionally, due to a substantial price increase by the drug manufacturer, Harvard Pilgrim now requires prior authorization for coverage of the medication Evzio on the Premium formulary. Evzio is a handheld auto-injector that delivers a single dose of naloxone to counter the effects of opioid overdose. Harvard Pilgrim’s Evzio Clinical Review Criteria detail the requirements that must be met in order to obtain prior authorization. To request prior authorization, please complete the Evzio Medication Request Form and fax it to MedImpact Healthcare Systems at 888-807-6643. For more information about Harvard Pilgrim pharmacy programs and medications policies, please refer to the Pharmacy page on Harvard Pilgrim’s provider website.

Email this article to a colleague   

Network Matters Archives

Download printer-friendly version


Coverage of Narcan Nasal Spray and Evzio

Vraylar: New Clinical Requirements for Coverage

Prior Authorization Required for Taltz

New Medical Policy on Treatment of Benign Prostatic Hypertrophy

Identifying and Treating Obsessive-Compulsive Disorder


Home Care Seasonal Flu Vaccine Fee Schedule Updated for 2016

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