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

September 2016

Prior Authorization Required for Lipitor


Effective immediately, Harvard Pilgrim will require prior authorization for coverage of brand-name Lipitor (atorvastatin) on the Premium formulary. Lipitor, a statin drug used to lower cholesterol, is covered at Tier 4 on the 4-Tier Premium formulary; it is not covered on the Value formulary. Generic atorvastatin will continue to be covered without prior authorization at Tier 1 on the 3-Tier Premium formulary and Tier 2 on the 4-Tier Premium formulary, and at Tier 1 on the 3- and 4-Tier Value formularies and Tier 2 on the 5-Tier Value formulary.
 
Harvard Pilgrim’s Lipitor Clinical Review Criteria detail the requirements that must be met in order to obtain prior authorization, including:

  • Patient tried and failed therapy with generic atorvastatin within the past year or the patient has a contraindication to the generic and
  • Patient tried and failed therapy with at least one alternative statin

Approvals for Lipitor are valid for a 12-month period. To request prior authorization, please complete the Lipitor Medication Request Form and fax it to MedImpact Healthcare Systems at 888-807-6643. For more information, refer to the Pharmacy section of Harvard Pilgrim’s provider website.

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PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator