harvard pilgrim health care policy updates
Track new and updated harvard pilgrim health care policies impacting reimbursement and clinical operations.
| Policy | Payer | Type | Specialty | Change | Effective |
|---|---|---|---|---|---|
| Medical Necessity Guidelines: Acne and Rosacea Medications | Harvard Pilgrim Health Care | Clinical | Dermatology | Modified | Aug 11, 2026 |
| Onapgo (apomorphine) and Vyalev (foscarbidopa/foslevodopa) - Prior Authorization | Harvard Pilgrim Health Care | Clinical | Neurology/Neurosurgery | Modified | Aug 11, 2026 |
| Akynzeo (netupitant/palonosetron) prior authorization | Harvard Pilgrim Health Care | Clinical | Pharmacy & Specialty Drugs | Modified | Aug 11, 2026 |
| 2026 Step Therapy Prior Authorization Medical Necessity Guidelines | Harvard Pilgrim Health Care | Clinical | Pharmacy & Specialty Drugs | Modified | Aug 1, 2026 |
| Prior authorization medical necessity guidelines — formulary product listings (partial) | Harvard Pilgrim Health Care | Clinical | Pharmacy & Specialty Drugs | Modified | Aug 1, 2026 |
| Intermittent Skilled Home Health Care — Medical Necessity and Authorization Criteria | Harvard Pilgrim Health Care | Clinical | Home Health & Hospice | Modified | Jul 1, 2026 |
| Adalimumab products — Prior authorization and medical necessity | Harvard Pilgrim Health Care | Clinical | Pharmacy & Specialty Drugs | Modified | Jul 1, 2026 |
| MassHealth changes to coverage and prior authorization of anti-obesity and GLP-1/GIP medications | Harvard Pilgrim Health Care | Clinical | Pharmacy & Specialty Drugs | Modified | Jul 1, 2026 |
| Prior Authorization Medical Necessity Guidelines — Partial drug list | Harvard Pilgrim Health Care | Clinical | Pharmacy & Specialty Drugs | Modified | Jul 1, 2026 |
| Tufts Medicare Preferred Prior Authorization Medical Necessity Guidelines (partial drug list) | Harvard Pilgrim Health Care | Clinical | Pharmacy & Specialty Drugs | Modified | Jul 1, 2026 |
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.
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Coverage data is sourced from publicly available payer medical policy documents and updated as payers publish revisions. Read more about where our data comes from. Always consult the primary payer source for clinical decision-making.