Insights and Updates for Providers

September 2024

Pharmacy coverage changes

Harvard Pilgrim Health Care Commercial | Tufts Health Direct | Tufts Health Plan Commercial | Tufts Health RITogether

Pharmacy coverage changes for various Point32Health products.

Connecticut market exit reminder

Harvard Pilgrim Health Care Commercial

Reminder about Harvard Pilgrim Health Care’s withdrawal of fully insured commercial products in Connecticut as of Jan. 1, 2024.

Maine mandates and new coverage

Harvard Pilgrim Health Care Commercial

Commercial medical necessity guideline updates to align with recent legislation in Maine.

Pharmacy coverage changes

Harvard Pilgrim Health Care Commercial | Tufts Health Direct | Tufts Health Plan Commercial | Tufts Health RITogether

Pharmacy coverage changes for various Point32Health products.

New ICD-10 code for HIV PrEP

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

HIV PrEP billing requirements and new ICD-10 code.

Pharmacy coverage changes

Harvard Pilgrim Health Care Commercial | Tufts Health Direct | Tufts Health Plan Commercial | Tufts Health RITogether

Jan. 1, 2024 Pharmacy coverage changes for various Point32Health products.

Preferred oncology biosimilars for 2024

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Preferred products for the bevacizumab, rituximab, and trastuzumab drug classes.

Other 2024 Pharmacy program updates

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

2024 Pharmacy updates: Harvard Pilgrim commercial, Tufts commercial, Tufts Health Direct.

Complex Care Management services

Harvard Pilgrim Health Care Commercial | Harvard Pilgrim Stride (HMO) Medicare Advantage | Tufts Health Plan Commercial | Tufts Health Public Plans | Tufts Medicare Preferred

Point32Health provides care management services for adult and pediatric members.

About Our Chronic Condition Management Programs

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Point32Health’s approach to chronic condition management through patient-centered care.

Inform Point32Health if you offer concierge medicine services

Harvard Pilgrim Health Care Commercial | Harvard Pilgrim Stride (HMO) Medicare Advantage | Tufts Health Plan Commercial | Tufts Medicare Preferred

Providers who are planning to offer concierge medicine services to eligible members are required to provide advance notice.

Synagis coverage for the 2023-2024 RSV season

Harvard Pilgrim Health Care Commercial | Tufts Health Direct | Tufts Health Plan Commercial | Tufts Health RITogether

Point32Health would like to remind providers of our Synagis (palivizumab) policy for the 2023-2024 season.