Harvard Pilgrim covers the medications Kymriah and Yescarta with prior authorization for members of our commercial and StrideSM (HMO) Medicare Advantage plans.
The respective commercial and Medicare Advantage policies for these drugs outline the indications they may be used to treat and the criteria that must be met for coverage. Effective immediately, we have updated the policies to indicate that Kymriah and Yescarta are not covered for members previously treated with any CAR-T Therapy.
For more information, please refer to the following updated policies:
- Commercial Kymriah Medical Policy
- Commercial Yescarta Medical Policy
- StrideSM (HMO) Medicare Advantage Kymriah Medical Policy
- StrideSM (HMO) Medicare Advantage Yescarta Medical Policy
Director, Network Operations