The Pharmacy Medical Necessity Guidelines below detail coverage criteria for Harvard Pilgrim Health Care and Tufts Health Plan lines of business.
We encourage you to use the drop-down menu to filter applicability by product. We note line of business under the guideline name; keep in mind, however, that the policy may not apply to every product in that line of business. Please refer to the policy for product applicability.
Tufts Health Together utilizes MassHealth’s Unified Formulary for pharmacy medications and select medical benefit drugs. In addition, for One Care, certain anti-obesity drugs are covered under MassHealth. For drug coverage and criteria refer to the MassHealth Drug List.
You can request authorization one of 4 easy ways! Learn more.