The chart below identifies updates to our Pharmacy program. For additional details, refer to the Pharmacy Medical Necessity Guidelines page on our Point32Health provider website, where you can find the policies that detail coverage criteria for our Harvard Pilgrim and Tufts Health Plan lines of business.
| Updates to existing prior authorization programs
Visit the Pharmacy Medical Necessity Guidelines page on our Point32Health provider website for details. |
||
| Drug/policy | Plan & additional information | Eff. date |
| Antidepressants | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct | May 1, 2024 |
| Antipsychotics Step Therapy Programs | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct | May 1, 2024 |
| Bylvay | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health RITogether | May 1, 2024 |
| Livmarli | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health RITogether | May 1, 2024 |
| Pretomanid tablet | Tufts Health RITogether | May 1, 2024 |
| Sedative Hypnotics Step Therapy | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct | May 1, 2024 |
| Wakefulness Agents | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct | May 1, 2024 |
Audrey Kleinberg,
Director, Provider Relations & Communications
Annmarie Dadoly,
Senior Manager, Provider Communications
Joseph O’Riordan, Susan Panos, Ellen Gustavson, Ryan Francis, Stephen Wong,
Writers
Kristin Edmonston,
Production Coordinator
Kristina Cicelova,
Graphic Designer