Our organization continuously evaluates our products in the market, and we have determined that as of Jan. 1, 2022, Harvard Pilgrim Health Care will no longer be offering Stride (HMO) Medicare Advantage plans in Massachusetts and Maine.

We’re pleased to announce that Point32Health, the parent company of Harvard Pilgrim Health Care and Tufts Health Plan, has selected OptumRx as the pharmacy benefit manager for all products, effective January 1, 2023.

With the 2021-2022 respiratory syncytial virus (RSV) season approaching, Harvard Pilgrim would like to remind providers of our policy regarding Synagis (palivizumab), an injection of antibodies used to protect high-risk infants from severe RSV disease.

Harvard Pilgrim is pleased to announce that our Quality Grant Program, which was established over 21 years ago, will continue to be offered in 2022 and beyond as a combined Point32Health program for providers in both of the heritage Harvard Pilgrim Health Care and Tufts Health Plan networks.

At the September 13, 2021 meeting, the Harvard Pilgrim Pharmacy & Therapeutics Committee reviewed certain medications and decided the following.

As a reminder, we encourage you to visit the COVID-19 page on our provider website to access resources designed to aid you in conducting operations during the pandemic, including any updates on COVID-19-related coverage, policies, and procedures; our COVID-19 coding grid; and our Interim Telemedicine and Telehealth Payment Policy.

Effective for Massachusetts commercial plans issued or renewed on or after Jan. 1, 2022, Harvard Pilgrim will cover the diagnosis and medically necessary treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS).

Beginning Oct. 8, 2021, Harvard Pilgrim will cover Empaveli and Ryplazim medications with prior authorization.

Harvard Pilgrim will accept new 2022 CPT and HCPCS codes for dates of service beginning Jan. 1, 2022 and will update fee schedules and policies as appropriate.

The integration of behavioral health with primary care has become an effective approach for facilitating the coordination of care between physical health and behavioral health providers.