2025 medical benefit step therapy program

Effective for fill dates on or after Jan. 1, 2025, a new medical benefit step therapy program will apply for Harvard Pilgrim Health Care Commercial products, Tufts Health Plan Commercial products, Tufts Health Direct, and Tufts Health Together. The goal of the program is to encourage the use of the least costly alternatives across a variety of therapeutic areas. The new coverage requirements will apply to patients initiating therapy with a non-preferred product.

Preferred and non-preferred products associated with the medical benefit step therapy program for Commercial products and Tufts Health Direct are as follows:

For Tufts Health Together, the following will apply:

For more information, please refer to our Medical Benefit Step Therapy Program Medical Necessity Guidelines (MNG) for Harvard Pilgrim Commercial, Tufts Health Plan Commercial, and Tufts Health Direct, as well as the equivalent MNG for Tufts Health Together, which you can find on the Medical Benefit Drug Medical Necessity Guidelines page on Point32Health’s provider website.