Massachusetts law states that the clinical review criteria used to establish a step therapy protocol cannot require members to utilize a medication that is not likely to be clinically effective for the prescribed purpose. Mandatory exceptions in step therapy protocols are now required.
Read more for information on updates to Point32Health’s Pharmacy prior authorization programs.
Read more for information on updates to Point32Health’s Pharmacy prior authorization programs.
In the April issue of Insights and Updates for Providers, Point32Health announced a number of changes expected to take effect June 1, 2023 in relation to the medical necessity review and prior authorization program that National Imaging Associates, Inc. (NIA) oversees on our behalf for certain procedures.
Effective July 1, 2023, Point32Health is updating our Commercial Group Insurance Commission product offerings, which will include the custom products Harvard Pilgrim Quality HMO and Harvard Pilgrim Explorer POS.
Point32Health is collaborating with Freespira, Inc. to offer a new, evidence-based pilot program, which is now available for eligible fully insured Commercial Harvard Pilgrim Health Care members ages 18 and over in Massachusetts, New Hampshire, and Maine.
Effective for dates of service beginning July 1, 2023, Point32Health will no longer provide reimbursement for claims submitted with modifiers TM and TR for services provided in conjunction with a student’s individualized education program.
Telehealth reimbursement update for commercial Massachusetts, Rhode Island, and Maine.
Please refer to this chart to review updates to pharmacy prior authorization programs applicable to Harvard Pilgrim Health Care and Tufts Health Plan products.