The chart below identifies updates to our medical benefit drug program. For additional details, refer to the Medical Necessity Guidelines associated with the medical drug in question, which you can find on our Point32Health (the parent company of Harvard Pilgrim Health Care and Tufts Health Plan) Medical Benefit Drug Medical Necessity Guidelines page.
Alternatively, some medical drugs are managed through an arrangement with OncoHealth when utilized for oncology purposes for Harvard Pilgrim members. You can find information about this program on the OncoHealth page in the Vendor Programs section of Point32Health’s provider website and you can access the prior authorization policies for these drugs directly on OncoHealth’s webpage for Harvard Pilgrim.
Tufts Health Together utilizes MassHealth’s Unified Formulary for pharmacy medications and select medical benefit drugs; for drug coverage and criteria refer to the MassHealth Drug List.
| New prior authorization programs | ||
| Drug/MNG | Plan & additional information | Eff. date |
Itvisma MassHealth Acute Hospital Carve-Out Drug List | Tufts Health Together Prior authorization will be required for coverage of Itvisma (C9309) under MassHealth’s Acute Hospital Carve-Out Drug Program. | 5/11/2026 |
| Updates to existing prior authorization programs | ||
| Drug/MNG | Plan & additional information | Eff. date |
| Yescarta | Harvard Pilgrim Commercial, Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health RITogether, Tufts Health One Care, Tufts Medicare Preferred, Tufts Health Plan Senior Care Options In alignment with recent updates in the FDA’s guidance, removed the limitation of use from Yescarta for patients with relapsed or refractory primary central nervous system lymphoma. | 5/1/2026 |
| Encelto | Harvard Pilgrim Commercial, Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health RITogether Criteria updated to specify that the provider is a retina specialist with expertise in treating retinal disorders. | 5/1/2026 |