The chart below identifies updates for Pharmacy Medical Necessity Guidelines. For additional details and to access the guidelines referenced below, please visit the Pharmacy Medical Necessity Guidelines page on our Point32Health provider website.
| Updates to existing prior authorization programs | |||
| Drug | Plan | Eff. date | Additional information |
| Filspari (sparsentan) | Harvard Pilgrim Commercial, Tufts Health Plan Commercial, Tufts Health Direct, RITogether | 11/1/2025 | Updated coverage criteria to include proteinuria ≥ 1 g/day, 3-month trial of angiotensin converting enzyme inhibitor (ACEi), angiotensin receptor blocker (ARB), sodium-glucose cotransporter-2 inhibitor (SGLT2i), and supportive care. Additionally, Filspari not to be used in combination with ACEi, ARB, endothelin receptor antagonist, or aliksiren. |
| Tarpeyo (budesonide) | Harvard Pilgrim Commercial, Tufts Health Plan Commercial, Tufts Health Direct, RITogether | 11/1/2025 | Updated coverage criteria to include proteinuria ≥ 1 g/day and 3-month trial of ACEi, ARB, SGLT2i, and supportive care. |