Updates to Existing Prior Authorization Programs
| Drug | Plan | Eff. date | Policy & Additional Information |
| Doptelet, Mulpleta, Tavalisse | Harvard Pilgrim Health Care commercial, Tufts Health Plan commercial, Tufts Health Direct | Nov. 1, 2023 | Thrombocytopenia Agents (Doptelet, Mulpleta, Tavalisse) (Harvard Pilgrim, Tufts Health Plan) |
| Doptelet, Mulpleta, Tavalisse | Tufts Health RITogether | Nov. 1, 2023 | Thrombopoietin Receptor Agonists |
| Alocril, Alomide, azelastine, bepotasine, emedastine, epinastine, Lastacaft, olopatadine | Tufts Health RITogether | Nov. 1, 2023 | Anti-Allergy Medications, Ophthalmic |
| Firdapse | Harvard Pilgrim Health Care commercial, Tufts Health Plan commercial, Tufts Health Direct, Tufts Health RITogether | Nov. 1, 2023 | Firdapse (amifampridine) (Harvard Pilgrim, Tufts Health Plan) |
| Livtencity (maribavir) | Harvard Pilgrim Health Care commercial, Tufts Health Plan commercial, Tufts Health Direct, Tufts Health RITogether | Nov. 1, 2023 | Livtencity (maribavir)(Harvard Pilgrim, Tufts Health Plan, Tufts Health RITogether) |
| Non-covered pharmacy products | Tufts Health RITogether | Nov. 1, 2023 | Pharmacy Products Without Specific Criteria |
| Opioids (short- and long-acting opioids without drug-specific criteria, fentanyl patch, morphine sulfate extended-release [MS Contin], Oxycodone extended-release [Oxycontin], benzhydrocodone/APAP, Belbuca, buprenorphine transdermal, fentanyl immediate-release, methadone, tramadol ER) | Tufts Health RITogether | Nov. 1, 2023 | Opioid Analgesics |
| Products with Quantity Limitations | Tufts Health RITogether | Nov. 1, 2023 | Products with Quantity Limitations |
| RI Opioid Prescribing Limits | Tufts Health RITogether | Nov. 1, 2023 | RI Opioid Prescribing Limits |
| Winlevi | Tufts Health RITogether | Nov. 1, 2023 | Acne and Rosacea Medications |
Drug Status Changes
| Drug | Plan | Eff. date | Policy & Additional Information |
| Tavalisse (fostamatinib disodium hexahydrate) | Tufts Health RITogether | Nov. 1, 2023 | Tavalisse will require prior authorization. |
Audrey Kleinberg,
Director, Provider Relations & Communications
Annmarie Dadoly,
Senior Manager, Provider Communications
Joseph O’Riordan, Susan Panos, Stephen Wong,
Writers
Kristin Edmonston,
Production Coordinator
Kristina Cicelova,
Graphic Designer