Point32Health would like to offer a number of reminders pertaining to our Pharmacy program.
Basal insulins coverage
Tufts Health RITogether
As we outlined in the November issue of Insights and Updates for Providers, effective Jan. 1, 2024 for Tufts Health RITogether, Basaglar (insulin glargine) KwikPen was moved to noncovered status. Prior authorization is required for new and existing utilizers. As of the Jan. 1 effective date, insulin glargine-yfgn vial and pen is covered without prior authorization. Please keep in mind that insulin glargine-yfgn is not interchangeable with Basaglar KwikPen at the pharmacy, and therefore a new prescription is required.
Inhaled Corticosteroid Inhalers
Tufts Health Together
Please keep in mind that brand name Flovent HFA (fluticasone propionate) and Flovent Diskus was discontinued at the end of 2023, and MassHealth has consequently made the following coverage updates in the inhaled corticosteroid inhaler class, effective Dec. 4, 2023:
- Brand Flovent HFA and Flovent Diskus continue to be covered without prior authorization. Members can fill brand Flovent HFA and brand Flovent Diskus until the supply runs out.
- Generic Flovent HFA and generic Flovent Diskus are not preferred and require prior authorization. Approval criteria for generic Flovent require documentation of an asthma diagnosis and trial and failure with at least two inhaled corticosteroids available without prior authorization.
- Arnuity Ellipta (fluticasone furoate inhalation powder) no longer requires prior authorization. Asmanex HFA (mometasone inhalation aerosol), Asamanex Twisthaler (mometasone inhalation powder) and Pulmicort Flexhaler (budesonide inhalation powder) continue to be covered without prior authorization.
Members already stable on brand Flovent inhalers may use generic fluticasone inhalers until March 4, 2024 to allow for a transition period while they are switched to another inhaler. After that time, generic fluticasone propionate inhalation powder will require prior authorization for all members. Beginning March 4, 2024, generic fluticasone propionate inhalation aerosol will be covered for members four years of age and younger; members five years of age and older will continue to require prior authorization.
Harvard Pilgrim commercial, Tufts Health Plan commercial, Tufts Health Direct
As noted above, brand Flovent HFA and Flovent Diskus inhalers were discontinued at the end of 2023 and moved to non-formulary status. Alternative covered inhalers on our Commercial and Direct formularies include Arnuity Ellipta, Pulmicort Flexhaler, and Qvar Redihaler.
However, we will continue to cover the authorized fluticasone propionate HFA inhaler for young pediatric members up to 6 years of age who require access to an HFA formulation. Once the member turns 7, step therapy will apply. Please consider prescribing one of the preferred inhalers listed above for members 7 and older.