Clinical Coverage Criteria and Request Forms
Access clinical guidelines and medication request forms for pharmacy drugs requiring prior authorization
Ways to Order Medication
Explore the ways you and your patients can quickly and easily order medications.
Learn how to submit exception requests for pharmacy drugs that Harvard Pilgrim limits or doesn’t cover.
As of Jan. 1, 2020, Harvard Pilgrim began utilizing OptumRx as our pharmacy benefit manager. Providers must obtain pharmacy prior authorizations through OptumRx and submit mail service prescriptions to OptumRx Home Delivery. Harvard Pilgrim manages our own drug formularies, the development of utilization management criteria, and appeals. Harvard Pilgrim uses CVS Specialty as our specialty pharmacy vendor, and Village Fertility Pharmacy and Freedom Fertility Pharmacy as our fertility pharmacy vendors.