As a reminder, Harvard Pilgrim Health Care does not require prior authorization for home infusion administration for Commercial members. (As we originally announced in the August 2023 provider newsletter, this aligned Harvard Pilgrim Commercial with Tufts Health Plan’s existing prior authorization policies for home infusion administration.)
Home infusion therapy involves the intravenous or subcutaneous administration of drugs or biologicals to a member at home. While authorization is not required for the administration of home infusion drugs, authorization is still required for the home infusion drugs themselves.
You can refer to our Medical Benefit Drug Medical Necessity Guidelines for details on drugs requiring prior authorization, but keep in mind that home infusion providers do not need to request prior authorization for any home infusion drug administration codes.
For more information, please refer to the updated Home Health Care Services Medical Necessity Guidelines.