The chart below identifies updates to our Pharmacy program. For additional details, refer to the Pharmacy Medical Necessity Guidelines page on our Point32Health provider website, where you can find the policies that detail coverage criteria for our Harvard Pilgrim and Tufts Health Plan lines of business.
| Updates to existing prior authorization programs | |||
| Drug | Plan | Eff. date | Policy and additional information |
| New-To-Market Drugs | Harvard Pilgrim Health Care commercial, Tufts Health Plan commercial, Tufts Health Direct | April 1, 2024 | New-To-Market Drugs |
| Orilissa | Tufts Health RITogether | April 1, 2024 | Endocrine Agents: Orilissa, Oriahnn, Myfembree, and Synarel |
| Drug status changes | |||
| Drug | Plan | Eff. Date | Policy and additional Information |
| Finacea gel | Tufts Health Together | Mar. 4, 2024 | Dermatologic Agents – Acne and Rosacea
Removing from the MassHealth Brand Preferred Over Generic List |
| Humira | Tufts Health RITogether | April 1, 2024 | Pharmacy Products Without Specific Criteria
Humira is moving to noncovered status. |
| Reyvow | Tufts Health RITogether | April 1, 2024 | Pharmacy Products Without Specific Criteria
Reyvow is moving to noncovered status. |
| Risperdal Consta | Tufts Health Together | Mar. 4, 2024 | Antipsychotics
Adding to the MassHealth Brand Preferred Over Generic List |