Updates Regarding Oncology Drugs

The following drugs will now require prior authorization through Oncology Analytics when used for oncology purposes for members of Harvard Pilgrim’s commercial and StrideSM (HMO) Medicare Advantage plans:

  • Cosela (HCPCS code C9078: Injection, trilaciclib, 1 mg)
  • Margenza (HCPCS code J9353: injection, margetuximab-cmkb, 5 mg)
  • Trodelvy (HCPCS code J9317: Injection, sacituzumab govitecan-hziy, 2.5 mg)

Oncology Analytics conducts medical review of chemotherapeutic protocols (chemotherapy, support and symptom management drugs) and radiation treatment plans for Harvard Pilgrim members with a cancer diagnosis that requires these services.

You can view prior authorization criteria for oncology drugs, as well as any recent coding updates, on the Oncology Analytics website. To request authorization, contact Oncology Analytics by fax (800-264-6128), phone (877-222-2021), or online via HPHConnect.


Publication Information

Helen Connaughton,
Director, Network Operations

Annmarie Dadoly,
Editor

Joseph O’Riordan,
Writer

Kristin Edmonston,
Production Coordinator