Harvard Pilgrim Health Care commercial, Tufts Health Plan commercial, and Tufts Health Direct require prior authorization for select long-acting opioids.
As we noted in the Dec. 2022 newsletter, prior authorization for long-acting opioids took effect for Harvard Pilgrim commercial members initiating a new course of treatment on or after Jan. 1, 2023, and members who were already taking a long-acting opioid would require authorization at a later date.
As a reminder, Harvard Pilgrim commercial members who are currently taking a long-acting opioid and who have not had a clinical review completed will require authorization on or after Nov. 1, 2023.
For more information, please refer to the Pharmacy Medical Necessity Guidelines for Opioid Analgesics.
Director, Provider Relations & Communications
Senior Manager, Provider Communications
Joseph O’Riordan, Susan Panos, Stephen Wong,