Drug coverage changes
DrugPlanEff. DatePolicy and Additional Information
TryngolzaHarvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct8/1/26

Non-Formulary Exceptions

Tryngolza is currently considered non-formulary and covered as an exception when the general criteria outlined on the Non-Formulary Exceptions Medical Necessity Guidelines (MNG) are met. 

Effective 8/1/26; however, the MNG will be updated to include more stringent drug-specific criteria which will need to be met in order for a non-formulary exception to be granted for Tryngolza.

Cefixime oral suspensionTufts Health RITogether8/1/26Cefixime oral suspension will be moved to non-formulary. Coverage will be reviewed according to our pharmacy medical necessity guideline titled Pharmacy Products Without Specific Criteria. Cefixime oral capsule will continue to be covered on formulary.
Entresto Sprinkle oral capsuleTufts Health RITogether8/1/26Entresto Sprinkle oral capsule will be moved to non-formulary. Coverage will be reviewed according to our pharmacy medical necessity guideline titled Pharmacy Products Without Specific Criteria. Generic sacubitril/valsartan oral tablet will continued to be covered on formulary.
XuridenTufts Health RITogether8/1/26Entresto Sprinkle oral capsule will be moved to non-formulary. Coverage will be reviewed according to our pharmacy medical necessity guideline titled Pharmacy Products Without Specific Criteria. 
Lumryz, XywavTufts Health RITogether8/1/26

Sodium Oxybate Products: Lumryz, Xyrem, and Xywav PMNG

For Lumryz and Xywav, criteria updated to require inadequate response, intolerance, or clinical inappropriateness of therapy with sodium oxybate oral solution (Xyrem) for diagnosis of narcolepsy with cataplexy and excessive daytime sleepiness in narcolepsy.