Pharmacy coverage changes

The following changes to Point32Health’s Pharmacy program take effect on Jan. 1, 2025:

Updates to existing prior authorization programs
Drug	Plan	Eff. date	Policy & additional information
Compound Medications	Harvard Pilgrim Health Care commercial, Tufts Health Plan commercial, Tufts Health Direct	1/1/2025	Compound Medications
Incretin Mimetics	Harvard Pilgrim Commercial, Tufts Health Plan Commercial, Tufts Health Direct	1/1/2025	Incretin Mimetics
Non-Formulary Exceptions	Harvard Pilgrim Commercial, Tufts Health Plan Commercial, Tufts Health Direct	1/1/2025	Non-Formulary Exceptions
Weight Loss Medications	Harvard Pilgrim Commercial, Tufts Health Plan Commercial, Tufts Health Direct	11/1/2024	Weight Loss Medications

Drug status changes
Drug	Plan	Eff. Date	Policy and Additional Information
Ingrezza (valbenazine), Leukeran (chlorambucil) tablet, Ocaliva (obeticholic acid), and teriparatide products	Harvard Pilgrim Commercial, Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health Together	1/1/2025	Ingrezza, Leukeran tablets, Ocaliva, and teriparatide products will be added to the specialty pharmacy program provided by Optum Specialty.
Xiaflex (collagenase clostridium histolyticum)	Harvard Pilgrim Commercial, Tufts Health Plan commercial, Tufts Health Direct	1/1/2025	Prior authorization will be required for fill dates effective on or after Jan. 1, 2025 for Xiaflex, approved by the FDA in February 2010 for the treatment of adults with Dupuytren’s contracture with a palpable cord and Peyronie’s disease with a palpable plaque and curvature deformity of at least 30 degrees at the start of therapy.

Other drug status and formulary updates

Please refer to the following lists to review other drug status and formulary changes for various products for the 2025 plan year:

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