Medical Drug Prior Authorization (CVS Health-Novologix)

CVS Health–NovoLogix conducts medical necessity and utilization review for the following medical drugs on behalf of Harvard Pilgrim — when they are used for purposes other than oncology. If you are utilizing a medical drug for oncology, prior authorization is necessary through OncoHealth (formerly Oncology Analytics). For more information, please refer to these resources: the OncoHealth link on the Medical/Clinical Policies webpage and the vendor programs resource page.

The following CVS Health–NovoLogix criteria are valid for dates of service beginning Sept. 1, 2020 and include dose and frequency guideline information.