We’re offering a reminder of some Pharmacy drug status and formulary updates for Oct. 1, 2026 for Commercial plans and Tufts Health Direct, as well as an additional update regarding a formulary status change for sodium-glucose cotransporter 2 (SGLT2) inhibitor drugs which will take effect Nov. 15, 2026 for Commercial large group members on the Premium, Value, and Select formularies.

Over-the-counter (OTC) drug exclusion reminder

As we announced previously, effective for dates of service beginning Oct. 1, 2026, Point32Health is making substantial drug status and formulary updates, which will impact Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, and Tufts Health Direct members. 

Most notably, we will no longer provide coverage for drug products that are explicitly over-the-counter or are prescriptions that have OTC equivalents, such as: 

  • 2nd generation antihistamines
  • H2 blockers
  • Nasal steroids
  • Prescription fluoride 
  • Proton pump inhibitors 

In instances where the drug product is a pediatric formulation, has no OTC equivalent, and/or is needed for benchmarking/mandated by the Affordable Care Act, the product will remain on the relevant formularies. 

Please refer to this document to review the drug status and formulary changes in detail. Changes include:

  • Over the counter drugs moving to excluded status, as outlined above
  • Drugs moving to non-formulary status
  • Prescription drugs moving to excluded status

Brand name SGLT2 inhibitor drugs moving to non-formulary status 

Additionally, effective for fill dates on or after Nov. 15, 2026 for Commercial large group plans, we’re implementing a generic-first SGLT2 inhibitor strategy and transitioning members from higher-cost brand name drugs to equivalent lower-cost generics or generic alternatives. 

All brand name SGLT2 inhibitors — widely used across diabetes, heart failure, and chronic kidney disease populations — will move to non-formulary status on our Premium, Value, and Select formularies. Generic dapagliflozin, or combination dapagliflozin/metformin ER, will be preferred. 

Brand name SGLT2 drugs moving to non-formulary include: 

  • Farxiga
  • Jardiance
  • Glyxambi
  • Synjardy
  • Synjardy XR
  • Trijardy XR
  • Xigduo XR

Members who are currently on Farxiga or Xigduo XR will be transitioned to generic equivalents automatically at the pharmacy and no action is needed. For members who are on any of the other brand drugs moving to non-formulary status, a new prescription for a preferred product will need to be written. For a member to continue using one of these non-formulary medications, the prescribing provider must request coverage as an exception through the medical review process subject to the Medical Necessity Guidelines for Non-Formulary Exceptions and Empagliflozin Containing Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors.