CommercialPrior AuthMedium impact
Point32Health medical drug program updates
Harvard Pilgrim Health Care·Hematology, Oncology, Endocrinology·Prior Authorization
Effective date
Dec 1, 2025
We identified it
Jun 20, 2026
Summary
Point32Health has updated their medical drug prior authorization requirements with three key changes: new consolidated guidelines for sickle cell disease gene therapies (Lyfgenia and Casgevy) effective 1/1/2026, and removal of prior authorization requirements for two Lupron Depot formulations (J9217 and J1950) effective 12/1/2025.
Action Required
Effective 12/1/2025: Update billing system to remove prior authorization requirements for HCPCS codes J9217 (Leuprolide acetate 7.5 mg) and J1950 (Leuprolide acetate 3.75 mg). By 1/1/2026: Update authorization workflows for sickle cell gene therapies J3394 (Lyfgenia) and J3392 (Casgevy) to use new consolidated Medical Necessity Guidelines and submit requests directly to Point32Health with 12-month authorization periods.