Point32Health requires prior authorization for many medical benefit drugs for our Harvard Pilgrim Health Care and Tufts Health Plan lines of business, and you can find prior authorization and coverage criteria for these drugs in the Medical Benefit Drug Medical Necessity Guidelines section of our provider website.
We recently encountered a temporary system error that resulted in a number of medically administered Medicare Part B drugs not appropriately requiring an authorization as they should for our Tufts Medicare Preferred, Tufts Health Plan Senior Care Options, and Tufts Health One Care members. You can find the list of drugs impacted by this system error on this page, which also designates whether or not each drug is associated with a Medicare Part B step therapy requirement.
This system error has been corrected and the drugs are now properly configured to require the necessary prior authorizations as a condition of coverage.
If any of your Tufts Medicare Preferred, Tufts Health Plan Senior Care Options, or Tufts Health One Care patients are currently taking any of these medications, and you have not previously obtained prior authorization, please submit a prior authorization request.
We appreciate your patience and understanding and apologize for any confusion this may cause.