Updates to Existing Prior Authorization Programs
| Drug | Plan | Eff. date | Policy & Additional Information |
| Aliskiren, Aliskiren/HCTZ, Amlodipine/atorvastatin, Amlodipine/valsartan/ HCTZ, Candesartan, Candesartan/HCTZ, Carvedilol ER, Diltiazem HCl coated beads tablet 24 hour tablets, Isradipine, Nimodipine, Nymalize, Edarbi, Eplerenone, Metoprolol tartrate, Nebivolol, Olmesartan/amlodipine, Telmisartan/HCTZ | Tufts Health RITogether | Dec. 1, 2023 | Antihypertension Medications |
| Azopt, Bimatoprost, Brimonidine, Combigan, Lumigan, Rescula, Rhopressa, Simbrinza, Tafluprost, Travoprost, Vyzulta, Xelpros Tufts Health RITogether Dec. 1, 2023 Glaucoma Medications Beconase AQ, Flonase Sensimist, Flunisolide, Mometasone, Omnaris, Qnasl, Qnasl Children’s, Zetonna |
Tufts Health RITogether | Dec. 1, 2023 | Nasal Corticosteroid Medications |
| Belsomra, DayVigo, Edluar, Ramelton Zolpidem ER tablet, Zolpidem SL tablet | Tufts Health RITogether | Dec. 1, 2023 | Hypnotic Medications |
| Cresemba, Posaconazole | Harvard Pilgrim Health Care commercial, Tufts Health Plan commercial, Tufts Health Direct | Dec. 1, 2023 | Oral Antifungal Agents (Harvard Pilgrim, Tufts Health Plan) |
| Fosamax+D, Risedronate | Tufts Health RITogether | Dec. 1, 2023 | Oral Bisphosphonate Medications (alendronate with vitamin D, risedronate) |
| Hetlioz, Hetlioz LQ | Tufts Health RITogether | Dec. 1, 2023 | Hetlioz (tasimelteon) |
| Ivermectin lotion, Spinosad | Tufts Health RITogether | Dec. 1, 2023 | Pediculicide Medications |
| Neo-Synalar | Harvard Pilgrim Health Care commercial, Tufts Health Plan commercial, Tufts Health Direct | Dec. 1, 2023 | Neo-Synalar (neomycin/fluocinolone) (Harvard Pilgrim, Tufts Health Plan) |
| Orilissa | Harvard Pilgrim Health Care commercial, Tufts Health Plan commercial, Tufts Health Direct | Dec. 1, 2023 | Endocrine Agents (Harvard Pilgrim, Tufts Health Plan) |
| Pregabalin, Pregabalin ER | Tufts Health RITogether | Dec. 1, 2023 | Pregabalin (Lyrica) and Pregabalin Extended-Release (Lyrica CR) |
| Semprex-D | Tufts Health RITogether | Dec. 1, 2023 | Non-Sedating Antihistamines |
| Sucralfate oral suspension | Tufts Health RITogether | Dec. 1, 2023 | Sucralfate oral suspension |
| Vigabatrin | Tufts Health RITogether | Dec. 1, 2023 | Vigabatrin |
Drug Status Changes
| Drug | Plan | Eff. date | Policy & Additional Information |
| Carafate oral suspension | Tufts Health RITogether | Dec. 1, 2023 | Sucralfate oral suspension
Generic substitution will be required. |
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