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

October 2016

Specialty Pharmacy Program Updates

Harvard Pilgrim’s Specialty Pharmacy Program has added the following medications for the Premium and Value formularies.

Name Indication Coverage Available From

Cabometyx (cabozantinib) 

Cabometyx is a kinase inhibitor indicated for the treatment of patients with advanced kidney cancer (renal cell carcinoma) whose cancer has spread or grown after treatment with other cancer medications.  Pharmacy  Accredo

Epclusa (sofosbuvir/velpatasvir) 

Epclusa is an oral single tablet regimen for the treatment of adults with chronic hepatitis C genotype 1, 2, 3, 4, 5, or 6 infection with or without cirrhosis (compensated). In patients with advanced cirrhosis (decompensated), Epclusa is used in combination with ribavirin. 

Pharmacy Accredo

Ocaliva (obeticholic acid) 

Ocaliva, a farnesoid X receptor (FXR) agonist, is indicated for the treatment of primary biliary cholangitis (PBC). It may be taken in combination with ursodeoxycholic acid (UDCA) in adults with an inadequate response to UDCA or alone in adults unable to tolerate UDCA.  

Pharmacy  Accredo

Taltz (ixekizumab) 

Taltz is a humanized interleukin-17A antagonist used to treat adults with moderate-to-severe plaque psoriasis who are candidates for systemic therapy or phototherapy. 

Pharmacy Accredo

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2017 CPT and HCPCS codes

Update to Formulas and Enteral Nutrition Prior Authorization Policy

Updates to Cardiovascular Disease Risk Tests Policy

Medicare Advantage Blood Glucose Monitoring Supplies

P&T Committee Updates

Specialty Pharmacy Program Updates

Updates to Clinical Medical Policies

ADHD Diagnosis and Follow-up Care


Outpatient Fee Schedule Updates

Assisting our Nurse Case Managers with Requests for Information

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