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

October 2016

Updates to Clinical Medical Policies


Harvard Pilgrim is updating the following clinical medical policies to include additional payable diagnosis codes, effective for dates of service beginning January 1, 2017:

  • Avastin (bevacizumab)
  • Erbitux (cetuximab)
  • Herceptin (trastuzumab)
  • Lucentis (ranibizumab)
  • Lupron Depot (leuprolide acetate)
  • Macugen (pegaptanib)
  • Reclast, Zometa (zoledronic acid)
  • Trelstar Depot, LA (triptorelin pamoate)
  • Velcade (bortezomib)

As a reminder, prior authorization is not required for these medications.

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P&T Committee Updates

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ADHD Diagnosis and Follow-up Care

OFFICE ASSISTANT

Outpatient Fee Schedule Updates

Assisting our Nurse Case Managers with Requests for Information

Keep Panel Status and Demographic Information Up to Date

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