Attention Harvard Pilgrim & TriCare patients

Harvard Pilgrim Health Care, Massachusetts’ 2nd largest Insurer, will NO longer be covering compounded prescription medication for patients 18 years and older. Harvard Pilgrim says it will stop the coverage on August 7th, but will still allow patients to appeal. Decisions will be made on a case-by-case basis and the burden will be on doctors to argue for use of the drugs.
We encourage you to take the following steps.
• Contact your employer’s Human Resources department and let them know how this policy change personally affects you, and ask them to contact Harvard Pilgrim and urge them to re-consider this decision.
• Contact your state representative and state senator and let them know what this change in coverage means to you and your family. The phone number for the Massachusetts State House is 617-722-2000.
• Contact Harvard Pilgrim and tell them how you are affected by this decision and say to them: “I will remember this when open enrollment comes next.”  The main phone number for Harvard Pilgrim is 617-509-1000.
• Ask your physician to submit an exception request through the process that Harvard Pilgrim has identified.
• Tell your pharmacist if you are willing to speak with the media about what the loss of this coverage will mean to you and your family.
– You can also access the Harvard Pilgrim Health Care Facebook page and voice your dissatisfaction with their decision.
Together, we need to take a stand to ensure that patients have access to their medications.

TRICARE: Resources and what you can do today
In June 2013, Express Scripts (ESI) sent a letter to all TRICARE beneficiaries receiving compounded medications that their prescriptions would no longer be reimbursed, effective July 24, 2013. Many of these letters list the ingredients that will no longer be reimbursed, but ESI clarified their position in an e-mail to pharmacy providers on June 26, 2013, stating that “Pharmacies may not be reimbursed for non-FDA approved ingredients used in the compounding of a prescription drug, including bulk chemicals.” By their very definition, bulk drug chemicals and inactive ingredients cannot go through an FDA approval process. Therefore, many of the ingredients that go into making a compounded medication for a patient will not be reimbursed for these patients.
To help you understand the situation and provide resources to communicate with patients, Department of Defense (DoD) and TRICARE officials, we have set up

*Information provided by PCCA

1 thought on “Attention Harvard Pilgrim & TriCare patients”

  1. I am SO HAPPY that you and two other pharmacies have filed a lawsuit against Harvard Pilgrim. We have no choice of ins co through my husband’s employer, so we are really upset – this isn’t the only thing they have done recently that is shocking.
    The medication I need is for an autoimmune condition – there is NO OTHER ALTERNATIVE MEDICINE FOR ME.
    I am more than happy to speak with any media, to submit an affidavit for the lawsuit – anything to bring attention to the unfair and blatant discrimination against adults.

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