Back to Insights and Updates for ProvidersAugust 2023

OncoHealth program update

Harvard Pilgrim Health Care Commercial  |  Harvard Pilgrim Stride (HMO) Medicare Advantage

In a continued effort to reduce prior authorization burden on providers and members, effective Sept. 1, 2023 the following drugs will no longer require prior authorization through OncoHealth for oncology indications for members of Harvard Pilgrim Health Care’s commercial and Medicare Advantage StrideSM (HMO)/(HMO-POS) plans.

Please be aware that this update is for the OncoHealth program and oncology indications only. Utilization management guidelines may apply for non-oncology indications; if any of these drugs have non-oncology indications, please refer to the Medical Necessity Guidelines on the Harvard Pilgrim website for a policy that may be in place for non-oncology indications.

J0893  Decitabine (Sun Pharma) J9351  Topotecan Hcl J9151  Daunorubicin Citrate Liposomal
J9181  Etoposide Phosphate J9293  Mitoxantrone Hcl J1559  Hizentra
J3489  Zoledronic Acid J0207  Amifostine Crystalline J1460  Immune Globulin,Gamma(Igg)
J0640  Leucovorin Calcium J9030  BCG Live J1575  Hyqvia
J9045  Carboplatin J0594  Busulfan J3590  Unclassified IVIG
J9267   Paclitaxel J3590  Cablivi J9218  Leuprolide Acetate
J9263  Oxaliplatin J9050  Carmustine J9219  Leuprolide Acetate/Lidocaine Hcl
J9000  Doxorubicin Hcl J9065  Cladribine J9230  Mechlorethamine Hcl
J9370  Vincristine Sulfate J9027  Clofarabine J9245  Melphalan Hcl
J1626  Granisetron Hcl J9100  Cytarabine J9245  Melphalan Hcl/Betadex Sulfobutyl Ether Sodium
J9280  Mitomycin J9130  Dacarbazine J2425  Palifermin
J9360  Vinblastine Sulfate J9120  Dactinomycin J2430  Pamidronate Disodium
J1190  Dexrazoxane Hcl J9150  Daunorubicin Hcl J9268  Pentostatin
J9040  Bleomycin Sulfate J9160  Denileukin Diftitox A9604  Samarium Sm 153 Lexidronam
J0894  Decitabine J1260  Dolasetron Mesylate J9320  Streptozocin
J9025  Azacitidine J9178  Epirubicin Hcl A9600  Strontium-89 Chloride
J9206  Irinotecan Hcl J9200  Floxuridine J9330  Temsirolimus
J9017  Arsenic Trioxide J9185  Fludarabine Phosphate J3316  Triptorelin Pamoate
J9201  Gemcitabine Hcl J1560  Gamma Globulin > 10 Cc Inj J2469  Palonosetron Hcl
J9171  Docetaxel J9211  Idarubicin Hcl
J9181  Etoposide J9208 Ifosfamide
J9060  Cisplatin J1558   Xembify

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