Updates to Existing Prior Authorization Programs
| Drug | Plan | Eff. date | Policy & Additional Information |
| Descovy | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct | Oct. 1, 2023 | Descovy and HIV Pre-Exposure Prophylaxis (PrEP) (Harvard Pilgrim, Tufts Health Plan) |
| Increlex | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health RITogether | Oct. 1, 2023 | Increlex (Harvard Pilgrim, Tufts Health Plan) |
| Lumryz, Xyrem, Xywav | Tufts Health RITogether | Oct. 1, 2023 | Sodium Oxybate Products: Lumryz, Xyrem, and Xywav |
| Non-Formulary Medications | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct | Oct. 1, 2023 | Non-Formulary Exceptions (Harvard Pilgrim, Tufts Health Plan) |
| Opioid Analgesics | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct | Oct. 1, 2023 | Opioid Analgesics (Harvard Pilgrim, Tufts Health Plan) |
| Opioids and Analgesics | Tufts Health Together | Oct. 2, 2023 | Opioids and Analgesics* |
| RI Opioid Prescribing Limits | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct | Oct. 1, 2023 | RI Opioid Prescribing Limits (Harvard Pilgrim, Tufts Health Plan) |
Drug Status Changes
| Drug | Plan | Eff. date | Policy & Additional Information |
| carglumic acid | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health Together | Oct. 1, 2023 | Carglumic acid will be added to the specialty pharmacy program provided by Optum Specialty |
| Tavalisse (fostamatinib disodium hexahydrate) | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health Together | Oct. 1, 2023 | Tavalisse will be added to the specialty pharmacy program provided by Optum Specialty |
*Tufts Health Plan maintains its own Opioids and Analgesics Pharmacy Medical Necessity Guidelines, which will be updated prior to Oct. 2, 2023 to align criteria with the MassHealth Unified criteria. Please refer to this policy for more information.
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