Insights and Updates for Providers

March 2023

Expanded access to CGP for advanced solid tumors

Tufts Health Direct  |  Tufts Health RITogether  |  Tufts Health Together

Point32Health and Foundation Medicine, Inc. previously expanded access to comprehensive genomic profiling (CGP) for Harvard Pilgrim Commercial members and Tufts Health Plan Commercial members, and that coverage now also applies to Tufts Health Together, Tufts Health RITogether, and Tufts Health Direct members.

Requests for assisted reproductive technology services

Harvard Pilgrim Health Care Commercial  |  Tufts Health Direct  |  Tufts Health Plan Commercial

We would like to provide some clarity regarding the correct processes for initiating prior authorization requests for assisted reproductive technology services for members of Harvard Pilgrim Health Care Commercial products, Tufts Health Plan Commercial products, and Tufts Health Direct.

Obtaining oral formulas

Harvard Pilgrim Health Care Commercial  |  Tufts Health Direct  |  Tufts Health Plan Commercial

Beginning April 1, 2023 for Harvard Pilgrim members, oral enteral formulas must be obtained through a contracted durable medical equipment provider, rather than at a retail pharmacy in order for them to be covered.

Acute behavioral health services for Tufts Health Plan

Tufts Health Direct  |  Tufts Health Plan MA Commercial products  |  Tufts Health Plan SCO  |  Tufts Health Together  |  Tufts Health Unify

Tufts Health Plan has updated the notification requirement for acute behavioral health services updated from two to three business days for Tufts Health Plan Massachusetts Commercial products, Tufts Health Together, Tufts Health Unify and Tufts Health SCO.

Pharmacy coverage changes

Harvard Pilgrim and Tufts Commercial  |  Tufts Health Direct  |  Tufts Health RITogether

Please refer to this chart to review updates to pharmacy prior authorization programs applicable to Harvard Pilgrim Health Care and Tufts Health Plan products.