Effective August 1, 2016, Harvard Pilgrim will require prior authorization for coverage of the medication Tresiba on the commercial Premium formularies. Tresiba is not covered on the Value formularies. Tresiba is a long-acting basal insulin indicated to improve glycemic control in adults with type 1 and type 2 diabetes.
To obtain prior authorization, providers must meet the requirements of the Tresiba Clinical Criteria. Please note that prior authorization will be required only for members new to treatment; you will not need to obtain prior authorization for your patients who are currently being prescribed Tresiba to control their glucose levels.
Approvals for the coverage of Tresiba will be valid for 12 months. To request prior authorization, please complete the Tresiba Medication Request Form and fax it to MedImpact Healthcare Systems at 888-807-6643. For more information, refer to the Pharmacy page on Harvard Pilgrim's provider website.