Pharmacy coverage changes
August 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 |
| Yesintek (ustekinumab-kfce) | Tufts Health RITogether | 10/1/2026 | Targeted Immunomodulators Self-administration Yesintek will be removed from the policy and will be non-formulary. Starjemza (ustekinumab-hmny) will be the preferred ustekinumab biosimilar and will be added to the policy requiring prior authorization. Starting 10/1/26, for new starts or new members, coverage for Yesintek will be reviewed according to the Pharmacy Products Without Specific Criteria MNG and Starjemza will be reviewed according to the Targeted Immunomodulators Self-administration MNG
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