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:
- Drugs moving to non-formulary status for 2025
- Drugs moving to a higher tier for 2025
- Drugs moving to excluded status for 2025
- Drugs with updated quantity limits for 2025
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