Back to Insights and Updates for ProvidersDecember 2023

Pharmacy coverage changes

Harvard Pilgrim Health Care Commercial  |  Tufts Health Direct  |  Tufts Health Plan Commercial  |  Tufts Health RITogether

Changes to existing prior authorization programs

Updates to existing prior authorization programs
Drug Plan Eff. date Policy & additional information
Advair HFA, Anoro Ellipta, Breo Ellipta, Budesonide/formoterol, Dulera, Proair Respiclick, Proair Digihaler Tufts Health RITogether Feb. 1, 2024 Respiratory Inhalers
Cyclosporine 0.05% ophthalmic emulsion, Cequa Tufts Health RITogether Feb. 1, 2024 Medications for Dry Eye Disease
Repatha Tufts Health RITogether Feb. 1, 2024 PCSK9 Inhibitor Therapy
Non-Formulary Exceptions Harvard Pilgrim Health Care commercial, Tufts Health Plan commercial, Tufts Health Direct Feb. 1, 2024 Non-Formulary Exceptions (Harvard Pilgrim, Tufts Health Plan)
Drug status changes
Drug Plan Eff. Date Policy and Additional Information
Forfivo XL Tufts Health Together Jan. 2, 2024 MassHealth is removing Forfivo XL from the Brand-Over-Generic List (BOGL). The generic will continue to require prior authorization.

Criteria can be found at the MassHealth Drug List (MHDL).

Please keep in mind that updated coverage and criteria will be available on the MHDL on or after the effective date.

Audrey Kleinberg,
Director, Provider Relations & Communications

Annmarie Dadoly,
Senior Manager, Provider Communications

Joseph O’Riordan, Susan Panos, Ryan Francis, Stephen Wong,

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Graphic Designer