As COVID-19 cases continue to fall and states begin to rescind emergency restrictions, Harvard Pilgrim has updated our COVID-19 procedures and policies accordingly.

We are delighted to announce that the combined organization of Harvard Pilgrim Health Care and Tufts Health Plan has appointed Cain Hayes as our next chief executive officer (CEO).

As a reminder, as part of our continuing network engagement series, we’re offering virtual sessions on claims and appeals this month.

We’re growing our library of training resources, and recently added two new short training videos to our Provider Training and Events page!

The 2021-2022 plan year for Harvard Pilgrim and the Group Insurance Commission’s (GIC’s) Primary Choice HMO and Independence Plan POS begins on July 1, 2021.

As a reminder, prior authorization is required from Harvard Pilgrim’s vendor partner Oncology Analytics for outpatient chemotherapy (infused and/or injected) and radiation therapy.

Harvard Pilgrim covers chimeric antigen receptor (CAR) T-cell immunotherapies for members of our commercial plans with prior authorization, and this coverage now includes the medication Breyanzi.

For dates of service beginning July 1, 2021, Harvard Pilgrim will require prior authorization through CVS-Novologix for the new drugs Amondys 45 and Nulibry for members of our commercial products.

Harvard Pilgrim covers the medication Rituxan and its biosimilars with prior authorization, and this coverage now includes the biosimilar Riabni.

Learn more about Harvard Pilgrim’s Commercial and Medicare Advantage medication adherence programs, which encourage members to properly adhere to their medication regimens.

Harvard Pilgrim covers chimeric antigen receptor (CAR) T-cell immunotherapies for members of our commercial plans, with prior authorization, and this coverage will include the medication Abecma beginning on July 1, 2021.

Harvard Pilgrim covers Nyvepria for members of our commercial and StrideSM (HMO) Medicare Advantage plans with prior authorization.

As a reminder, Harvard Pilgrim covers monoclonal antibody treatment in an outpatient setting for mild to moderate COVID-19 in patients who are at high risk for progressing to severe COVID-19 and/or hospitalization.

Please review this reminder on the importance of reviewing provider data in the directory regularly and keeping the information up to date.

Effective for dates of service beginning Aug. 1, 2021, several new drugs will require prior authorization through Oncology Analytics when used for oncology purposes.

As you are likely aware, Health Plans, Inc. (HPI), a Harvard Pilgrim company, is a third-party administrator that provides services to self-insured groups.

Updates to Harvard Pilgrim’s standard home care seasonal influenza vaccine fee schedule will take effect on Aug. 1, 2021. To request an updated fee schedule, please call the Provider Service Center at 800-708-4414.

Harvard Pilgrim covers outpatient physical and occupational therapy, with prior authorization, for members of our Medicare Advantage plans.