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.