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
Visit the Pharmacy Medical Necessity Guidelines page on our Point32Health provider website for details. |
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| Drug/policy | Plan & additional information | Eff. date |
| Evrysdi (risdiplam) | Harvard Pilgrim Commercial, Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health RITogether | 8/1/2024 |
| Alcaftadine, azelastine, bepotastine, epinastine, lodoxamide, nedocromil, olopatadine
Anti-Allergy Medications, Ophthalmic |
Tufts Health RITogether | 8/1/2024 |
| Asenapine, Caplyta, Fanapt, Lurasidone, Lybalvi, Nuplazid, Pimozide, Quetiapine extended-release, Rexulti, Secuado, Vraylar
Antipsychotics |
Tufts Health RITogether | 8/1/2024 |
| Auryxia
Ferric citrate (Auryxia) |
Tufts Health RITogether | 8/1/2024 |
| Flector, Licart, Pennsaid, Sprix
Nonsteroid Anti-Inflammatory Drugs (NSAIDs) |
Tufts Health RITogether | 8/1/2024 |
| Intrarosa (prasterone) | Tufts Health RITogether | 8/1/2024 |
| Lubiprostone, Ibsrela, Linzess, Motegrity, Movantik, Symproic, Relistor, Viberzi
Gastrointestinal Medications |
Tufts Health RITogether | 8/1/2024 |
| Osphena (ospemifene) | Tufts Health RITogether | 8/1/2024 |
| Qbrexza (glycopyrronium) | Tufts Health RITogether | 8/1/2024 |
| Ranolazine extended-release | Tufts Health RITogether | 8/1/2024 |
| Tezspire (tezepelumab-ekko) | Tufts Health RITogether | 8/1/2024 |
| Zirgan
Anti-Infective Medications, Ophthalmic |
Tufts Health RITogether | 8/1/2024 |