Elevidys moved to non-covered due to FDA concerns
Point32Health will no longer offer coverage of Elevidys for dates of service on or after July 22, 2025 due to the FDA’s announcement of safety concerns.
Insights and Updates for Providers
August 2025
Telehealth flexibilities for Medicare members
Tufts Health Plan is extending some telehealth flexibilities for Medicare members and offering guidance on telehealth billing for these members.
Expansion of vendor program for spine and interventional pain management services
Point32Health is expanding its Evolent program to include utilization management for spine and interventional pain management services for Tufts Medicare Preferred members.
Upcoming coverage changes for diabetic testing supplies
Accu-Chek will become the preferred brand for blood glucose meters and test strips, and LifeScan’s One Touch test strips and meters will no longer be covered under the patient’s benefit.
Updates to CBHI-FIT program Medical Necessity Guidelines
We have updated our Children’s Behavioral Health Initiative Family-based Intensive Treatment (FIT) Medical Necessity Guidelines to reflect the state’s new requirements.
Preventive screenings at-home for select members
Beginning in late July, we will offer at-home screenings at no member cost for colorectal cancer, kidney disease/HbA1c, diabetic eye disease, and bone density.
New open access product offerings
We’re offering open access versions of the Harvard Pilgrim Health Care Focus Network – MA and ChoiceNet HMO plans for employees of the Massachusetts Strategic Health Group (MSHG).
Updates to Targeted Case Management Services’ ICC Medical Necessity Guidelines
We’ve revised our Targeted Case Management Services: Intensive Care Coordination (ICC) Medical Necessity Guidelines to reflect the state’s updated guidance.
2025 Home Care Seasonal Flu Vaccine Fee Schedule
The updated 2025 home care seasonal flu vaccine fee schedule will take effect on Oct 1, 2025.
Behavioral Health and substance use disorder tools and resources
Providers of behavioral health services for Tufts Health RITogether can use a variety of resources on our dedicated web pages to facilitate care for patients.
Reminder: One Care training requirement
Our online resources make it easy to complete training on the One Care (Medicare-Medicaid dual eligible) program.
New Point32Health Hospice Payment Policy
We’ve developed an integrated Point32Health Hospice Payment Policy, which is available in the Payment Policies section of our provider website.
Coordinating care for medical and behavioral health
We offer many resources for coordination of care for medical and behavioral health, a key to improving health outcomes.
Reducing 30-day readmissions
Timely follow-up and patient education are key priorities when it comes to reducing hospital readmissions within 30 days.
Initiation and engagement of substance use disorder treatment (IET)
We are offering best practices for Initiation and Engagement Substance Use Disorder Treatment, which can help improve patient outcomes.
Point32Health Medical Necessity Guideline updates
Refer to this chart to review changes and updates to Point32Health’s Medical Necessity Guidleines, information on newly developed MNGs, and more.
Point32Health medical drug program updates
Refer to this chart to review changes and updates to Point32Health’s medical drug program, including information about prior authorization, coverage updates, and more.
MassHealth updates to Unified Formulary
MassHealth recently announced updates to the MassHealth Unified Formulary, which will take effect on Oct. 1, 2025.
Pharmacy coverage changes
Refer to this chart for information regarding upcoming pharmacy coverage changes.