Back to Insights and Updates for ProvidersFebruary 2023

Pharmacy and medical drug authorization reminders

All products

Point32Health began utilizing Optum RX as the pharmacy benefit manager for all lines of business as of Jan. 1, 2023. Please note the following:

For Harvard Pilgrim Health Care members

  • Authorization requests for pharmacy drugs — and medical benefit drugs used for non-oncology purposes — should be made directly to Point32Health. If you are utilizing a medical drug for oncology purposes, prior authorization is necessary through OncoHealth. As of April 1, 2023, for Harvard Pilgrim members, radiation oncology will no longer require prior authorization from OncoHealth (see related article in this issue). For more information, please refer to these resources: the Oncology/OncoHealth link on the Harvard Pilgrim Medical/Clinical Policies webpage and the vendor programs resource page.
  • Any open pharmacy authorizations — obtained prior to Jan. 1, 2023 — will be honored for the length of the approval and you do not need to request a new authorization.
  • Any approved authorizations for medical benefit drugs will also be honored and remain active through the end date of the authorization. For existing Harvard Pilgrim Health Care Commercial members this means that any authorizations that were reviewed and approved by CVS Health-Novologix will be uploaded into Harvard Pilgrim Health Care’s systems and will be honored.

For Tufts Health Plan members

  • Authorization requests for pharmacy drugs and all medical benefit drugs should be made directly to Point32Health.
  • Any open pharmacy authorizations — obtained prior to Jan. 1, 2023 — will be honored for the length of the approval and you do not need to request a new authorization.
  • Any approved authorizations for medical benefit drugs will also be honored and remain active through the end date of the authorization.
  • For members moving from Tufts Health Plan Commercial plans to Harvard Pilgrim Health Care Commercial plans, any open medical drug benefit authorizations will also continue to be valid through the end date identified on the authorization.

For all members
Authorization for pharmacy benefit and medical benefit drugs (other than those used for oncology purposes for Harvard Pilgrim Health Care) can be requested in one of the following ways:

  • PromptPA — View drug-specific criteria, attach clinical information, check the status of requests made through PromptPA, and receive a response more quickly. Submit your request at point32health.promptpa.com.
  • Electronic PA (ePA) — Utilize ePA through EMR, CoverMyMeds (for both pharmacy and medical benefit drugs), or Surescripts (for pharmacy drugs only)
  • FAX — Submit your request using the corresponding form (found on Harvard Pilgrim’s pharmacy medical necessity guideline page and Tufts Health Plan’s Resource Center) and fax to the number indicated on the form.
  • Mail prior authorization form to: Point32Health (Harvard Pilgrim Health Care/Tufts Health Plan)
    Attn: Pharmacy Utilization Management Department
    1 Wellness Way, Canton, MA 02021-1166

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