Pharmacy coverage changes
January 2026| Harvard Pilgrim Health Care Commercial| Tufts Health Plan Commercial| Tufts Health Direct| Tufts Health RITogether| Tufts Health Together
The chart below identifies updates for Pharmacy Medical Necessity Guidelines. For additional details and to access the guidelines referenced below, please visit the Pharmacy Medical Necessity Guidelines page on our Point32Health provider website.
| Drug status changes | |||
| Drug | Plan | Eff. Date | Policy and Additional Information |
| New to Market Drugs | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct | 4/1/26 | Non-Formulary Exceptions New to market drugs will be excluded from coverage and may be subject to an exception under the Non-formulary Exceptions MNG. Editor's note: this initiative was delayed to a June 1, 2026 effective date. |
| Sucraid (sacrosidase) | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct | 3/1/2026 | Sucraid will be moved to non-formulary status with quantity limit. |
| Winlevi | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct | 4/1/2026 | Topical Acne Medications (previously named Topical Retinoids) Added criteria for Winlevi. |