Back to Insights and Updates for ProvidersAugust 2023

Prenatal vitamin coverage update

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

Effective for fill dates on or after Jan. 1, 2024, Harvard Pilgrim Health Care Commercial Plans, Tufts Health Plan Commercial Plans and Tufts Health Plan Direct will only cover prescription generic prenatal vitamins on our pharmacy formulary. Brand and generic over-the-counter prenatal vitamins will be excluded. All brand prescription prenatal vitamins will be moved to non-formulary.

Please refer to the formulary for information on prenatal vitamins. You can find formulary information on the pharmacy pages of the Harvard Pilgrim Health Care and Tufts Health Plan provider websites.

To request that a patient continue to receive coverage for a non-formulary prenatal vitamin, the prescribing provider must request an exception through the pharmacy review process under the Pharmacy Medical Necessity Guidelines for Non-Formulary Exceptions policy. (You can find information and forms/resources to guide you in requesting an exception on Tufts Health Plan’s Utilization Management webpage.)

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