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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