Point32Health partners with OncoHealth to operate our oncology medical management program for Harvard Pilgrim Health Care Commercial members, and effective for dates of service beginning Jan. 1, 2026, we’re expanding the scope of the program to include Tufts Medicare Preferred members. 

Program overview                                      

Through this program,  prior authorization is required for outpatient chemotherapy (infused and/or injected) drugs and OncoHealth conducts medical review of chemotherapeutic protocols (chemotherapy, support, symptom management drugs) for members with a cancer diagnosis who require these services. In addition to National Coverage Determinations and Local Coverage Determinations for Medicare, OncoHealth utilizes current, evidence-based, disease-specific analytics on all cancer types and treatment options, backed by board-certified oncologists and oncology pharmacists. 

For more information, please refer to the OncoHealth page in the vendor programs section of our provider website, as well as OncoHealth’s dedicated webpage for Point32Health members and providers. 

Medical drug authorization program reminder

Please keep in mind that some of the drugs in the oncology program currently require prior authorization directly through Point32Health as part of our typical medical drug management program. As of Jan. 1, those drugs will require prior authorization from OncoHealth instead — when used for oncology purposes. However, if the drug is being used to treat other conditions for our Tufts Medicare Preferred members, it will still require authorization from Point32Health. Please refer to the Medical Benefit Drug Medical Necessity Guidelines page to view the medical drugs in that program as well as the medical review criteria.

Current approved authorizations for these drugs (obtained directly through Tufts Health Plan) will continue to be valid and a new authorization isn’t required in these instances.

Requesting authorization and submitting claims

Providers may request authorization from OncoHealth for outpatient chemotherapy drugs via:

  • OneUM — Submit requests to OncoHealth for Tufts Medicare Preferred members using OneUM, their online authorization portal. (As a reminder, for Harvard Pilgrim members you should continue to use the single sign-on feature in HPHConnect for OncoHealth requests.)
  • Fax — Fax your request and clinical records to 800-264-6128
  • Phone — Submit requests by calling 888-916-2616 (with any necessary clinical documentation faxed to the number above and appropriate reference number included) 

Please continue to submit claims directly to Point32Health as you do today. (See the Claim Requirements, Coordination of Benefits and Payment Disputes section of the Tufts Health Plan Senior Products Provider Manual.)

Sign up for a webinar

In addition, OncoHealth is offering webinars for providers and office staff to provide an overview of the program and instruction on using their e-prior authorization system — and attendees will receive their username and password. There will also be an opportunity to ask questions. Webinars will be offered on the following Tuesdays and Thursdays in December and January. 

Tuesdays at 1 p.m. EST (register here): 

  • December 2
  • December 9
  • December 16
  • December 30
  • January 6
  • January 13
  • January 20

Thursdays at 11 a.m. EST (register here): 

  • December 4
  • December 11
  • December 18
  • January 8
  • January 15
  • January 22