Medical Drug Prior Authorization (CVS Health-Novologix)

Through Dec. 31, 2022, 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. The following CVS Health–NovoLogix criteria include dose and frequency guideline information.

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.

New for 2023: Point32Health is streamlining the utilization management for pharmacy and medical drugs — including managing the intake of and conducting review of pharmacy and medical drug prior authorization requests in-house. Effective Jan. 1, 2023, submit requests for authorization for pharmacy and medical benefit drugs directly to Harvard Pilgrim Health Care. CVS Health-NovoLogix will no longer accept medical drug prior authorization requests for Harvard Pilgrim members. See our new Medical Drug Medical Necessity Guideline page for more.