| Updates to existing prior authorization programs | |||
| Drug | Plan | Eff. date | Policy & additional information |
| Ravicti (glycerol phenylbutyrate) | Harvard Pilgrim Commercial, Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health RITogether | 4/1/2025 | Ravicti
Updates to step therapy requirements within coverage criteria, updates to diagnosis requirements, and a requirement added that the requested medication be used as an adjunct to a protein-restricted diet. |