The Medical Necessity Guidelines below detail coverage criteria for Harvard Pilgrim Health Care and Tufts Health Plan lines of business. We encourage you to use the drop-down menu to filter by product. We note line of business under the guideline name; the policy may not apply to every product in that line of business. For product applicability, refer to the policy.
Tufts Health Together utilizes MassHealth’s Unified Formulary for select medical benefit drugs (see the MassHealth Drug List).