Effective for dates of service beginning Dec. 1, 2021 for members of our commercial plans, Harvard Pilgrim will require prior authorization for the medications Nexviazyme and Saphnelo, both of which utilize CPT code J3590 (Unclassified biologics).
Nexviazyme is indicated for the treatment of patients one year of age and older with late-onset Pompe disease (lysosomal acid alpha-glucosidase [GAA] deficiency), and Saphnelo is used to treat adult patients with moderate-to-severe systemic lupus erythematosus, who are receiving standard therapy. The efficacy of Saphnelo has not been evaluated in patients with severe active lupus nephritis or severe active central nervous system lupus and use of the drug is not recommended for these patients.
To request authorization, please contact CVS Health–NovoLogix via phone (844-387-1435) or fax (844-851-0882).
For complete information — including criteria for initial approvals and continuation of therapy, supplemental documentation necessary to initiate the prior authorization review, and FDA-approved maximum dosage and frequency limits — please refer to the Nexviazyme and Saphnelo Medical Policies.