Pharmacy coverage changes
July 2026| Our products| 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 |
| Dupixent (dupilumab) | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct | 9/1/2026 | Dupixent (dupilumab) Changes to non-dermatological indications include, but are not limited to, increased emphasis on chart-confirmed diagnosis and response to therapy, increased emphasis on disease severity, more explicit concurrent therapy requirements, clearer separation of failure of treatment alternatives vs requested use as add-on therapy, and standardization of minimum treatment durations of non-biologic therapies. |
| Fasenra (benralizumab) | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct | 9/1/2026 | Fasenra (benralizumab) Pen (autoinjector) Changes include, but are not limited to, increased emphasis on chart-confirmed diagnosis and response to therapy, increased emphasis on disease severity, more explicit concurrent therapy requirements, clearer separation of failure of treatment alternatives vs requested use as add-on therapy, and standardization of minimum treatment durations of non-biologic therapies. |
| Nucala (mepolizumab) | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct | 9/1/2026 | Nucala (mepolizumab) Pre-Filled Autoinjector and Syringe Changes include, but are not limited to, increased emphasis on chart-confirmed diagnosis and response to therapy, increased emphasis on disease severity, more explicit concurrent therapy requirements, clearer separation of failure of treatment alternatives vs requested use as add-on therapy, standardization of minimum treatment durations of non-biologic therapies, and standardization of duration of approval rules. |
Tezspire (tezepelumab-ekko)
| Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct | 9/1/2026 | Tezspire (tezepelumab-ekko) Pre-Filled Pen Changes include, but are not limited to, increased emphasis on chart-confirmed diagnosis and response to therapy, increased emphasis on disease severity, more explicit concurrent therapy requirements, clearer separation of failure of treatment alternatives vs requested use as add-on therapy, and standardization of minimum treatment durations of non-biologic therapies. |
| Xolair (omalizumab) | Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct | 9/1/2026 | Xolair (omalizumab) Pre-filled Syringe for Self-Administration Changes include, but are not limited to, increased emphasis on chart-confirmed diagnosis and response to therapy, increased emphasis on disease severity, more explicit concurrent therapy requirements, clearer separation of failure of treatment alternatives vs requested use as add-on therapy, standardization of minimum treatment durations of non-biologic therapies, and standardization of duration of approval rules. |
Non-preferred Statin Medications:
| Tufts Health RITogether | 9/1/26 | Non-preferred statin medications will be moved to non-formulary. Coverage will be reviewed according to our Pharmacy Medical Necessity Guidelines for Pharmacy Products Without Specific Criteria. Generic atorvastatin tablet, lovastatin tablet, pravastatin tablet, rosuvastatin tablet, and simvastatin will continue to be covered without prior authorization. |