Back to Insights and Updates for ProvidersNovember 2024

Removing certain drugs from white bagging program

Harvard Pilgrim Health Care Commercial  |  Tufts Health Direct  |  Tufts Health Plan Commercial  |  Tufts Medicare Preferred

Effective for dates of service beginning Jan. 1, 2025, certain medications will no longer be offered as part of our office-administered medical drug/white bagging program.

The drugs identified below will be removed from the Office-Administered Medical Drugs list for Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Medicare Preferred, and Tufts Health Direct plans and will no longer be available through CVS Caremark.

  • Actemra (J3262)
  • Remicade (J1745)
  • Orencia (J0129)
  • Simponi Aria (J1602)

Providers can continue to buy and bill these medications once prior authorization has been obtained. You can request prior authorization in a number of ways, but we recommend submitting requests electronically through PromptPA for ease of use and quick turnaround times. In addition, some of the medications may be available under our Pharmacy benefit. Please refer to the relevant plan’s online formulary to confirm Pharmacy drug coverage.


Annmarie Dadoly,
Senior Manager, Provider Communications

Joseph O’Riordan,
Editor

Susan Panos, Ellen Gustavson, Ryan Francis, Stephen Wong,
Writers

Kristin Edmonston,
Production Coordinator

Kristina Cicelova,
Graphic Designer