You may request prior authorization for a pharmacy or medical benefit drug in one of the following ways:
- PromptPA — With this online tool you can quickly and easily submit requests for pharmacy and medical benefit drugs. View drug-specific criteria, attach clinical information, check the status of your PromptPA request, and receive a response more quickly. Submit your request or view the PromptPA User Guide for more information.
- Electronic PA (ePA) — Utilize ePA through EMR, CoverMyMeds (for both pharmacy and medical benefit drugs), or Surescripts (for pharmacy drugs only)
- FAX — Submit your request using the corresponding form found below and fax to the number indicated on the form.
- Mail prior authorization form to the appropriate Plan:
Harvard Pilgrim Health Care/Tufts Health Plan
Pharmacy Utilization Management Department
1 Wellness Way
Canton, MA 02021-1166
Commercial (including Tufts Health Direct)
- Massachusetts Standard Form for Medication Prior Authorization Requests
- Massachusetts Standard Form for Hepatitis C Prior Authorization Requests
- Massachusetts Standard Form for Synagis® Prior Authorization Requests
- Massachusetts Standard Form for Chemotherapy and Supportive Care Prior Authorization Requests
- Tufts Health Plan Medication Prior Authorization Request Form (Non-Massachusetts Providers)
Tufts Medicare Preferred, Tufts Health Plan Senior Care Options, Tufts Health One Care
- Hepatitis C Medication Request Form
- Request for Medicare Prescription Drug Coverage Determination (Tufts Medicare Preferred)
- Request for Medicare Prescription Drug Coverage Determination (Senior Care Options)
- Request for Medicare Prescription Drug Coverage Determination (Tufts Health One Care)
- Coverage Determination and Prior Authorization Request for Medicare Part B vs Part D
Tufts Health RITogether
Tufts Health Together
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.