Point32Health is implementing the following 2024 Pharmacy updates, which are applicable to our Harvard Pilgrim commercial, Tufts Health Plan commercial, and Tufts Health Direct products.
New step therapy programs
Effective for fill dates on or after Jan. 1, 2024, we are instituting a step therapy requirement for fluticasone propionate HFA inhalation, as well as Motegrity (prucalopride) tablet.
Before being prescribed fluticasone propionate HFA inhalation, members will need to have first attempted treatment with the preferred agents Qvar RediHaler, Arnuity Ellipta, and Pulmicort Flexhaler. This step therapy program applies to members 7 years of age or older. For these requests, the prescribing provider must request coverage through the medical review process subject to the pharmacy medical necessity guidelines for Fluticasone propionate HFA Step Therapy Program (Harvard Pilgrim, Tufts Health Plan).
In order to be covered for Motegrity, members will need to have first tried and failed treatment with the preferred agents lubiprostone and Linzess. This coverage change applies to members initiating a new course of treatment; those who are already taking this drug during their current course of treatment will be able to continue to do so without prior authorization. To request an exception, the prescribing provider must request coverage through the medical review process subject to the pharmacy medical necessity guidelines for Motegrity (prucalopride) Step Therapy Program (Harvard Pilgrim, Tufts Health Plan).
Inhaler coverage update for young pediatrics
On Dec. 31, 2023, the Flovent HFA and Flovent Diskus inhalers will be discontinued and moved to non-formulary status. Alternative covered inhalers on our formulary include Arnuity Ellipta, Pulmicort Flexhaler, and Qvar Redihaler.
However, we will continue to cover the authorized fluticasone propionate HFA inhaler for young pediatric members up to 6 years of age who require access to an HFA formulation. Fluticasone propionate HFA inhalation is covered for members up through age 6. Once the member turns 7, step therapy will apply. Please consider prescribing one of the preferred inhalers listed above for members 7 and older.
In order for a member 7 years of age or older to receive coverage for the authorized generic fluticasone propionate HFA inhaler, the prescribing provider must request coverage through the medical review process subject to the pharmacy medical necessity guidelines for Fluticasone propionate HFA Step Therapy Program (Harvard Pilgrim, Tufts Health Plan).
Aspirin coverage update
Beginning Jan. 1, 2024, we’re making changes to our Aspirin coverage, in accordance with recommendations from the U.S. Preventive Services Task Force.
Aspirin 81mg formulations will be excluded from coverage for members under age 12 and older than 51. While Apririn 81mg will remain covered in full for members ages 12 through 51, all other formulations of aspirin greater than 81mg (all strengths) will be excluded from coverage.
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