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

July 2016

Coverage of Vitamin B12 Screening and Testing

Harvard Pilgrim has developed a new medical policy for Vitamin B12 screening and testing. Effective for dates of service beginning October 1, 2016, Harvard Pilgrim does not consider routine vitamin B12 screening and testing in healthy, asymptomatic adults medically necessary and will not offer reimbursement for this testing in these cases.

Harvard Pilgrim will offer coverage of medically necessary vitamin B12 screening and testing for members who are clinically symptomatic or considered high-risk for deficiency due to certain medical conditions. For a complete list of the conditions in which vitamin B12 screening and testing is considered medically necessary, please refer to the Vitamin B12 Screening and Testing Medical Policy.

In addition, Harvard Pilgrim considers the testing of methylmalonic acid (MMA) medically necessary for the diagnosis of vitamin B12 deficiency when vitamin B12 levels are borderline-low or low.

However, the testing of holo-transcobalamin as a marker of vitamin B12 is considered investigational/experimental.

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Substance Abuse Materials Now Available Online


Medical Policy Changes for Injectable and Infusible Drugs

Coverage of Vitamin B12 Screening and Testing

Coverage of Tumor Treatment Field Device for Glioblastoma

Briviact Covered With Prior Authorization

Nuplazid Covered With Prior Authorization

New Medical Policy for H. Pylori Testing

New Medical Policy for Nucala

Tier Increase for Apidra and Apidra SoloSTAR on the Premium Formulary

Tier Increase for Edecrin on the Premium Formulary

Diagnosing and Treating Depression in Older Adults

P&T Committee Meeting Update

Specialty Pharmacy Update


Reminder: Keep Panel Status and Demographic Information 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