Pharmacy coverage changes
April 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 |
| Hernexeos | Harvard Pilgrim Commercial, Tufts Health Plan Commercial, Tufts Health Direct | 6/1/2026 | Antineoplastics Pharmacy Medical Necessity Guideline Updated coverage criteria for Hernexeos to require documentation that patient has not experienced disease progression on another HER2 tyrosine kinase inhibitor (TKI). |