Prior Authorization

Here, in one convenient place, you’ll find the prior authorizaton materials that you may need to reference to provide care for our members. We recommend using our secure portals (Tufts Health portal for Tufts Health Plan members or HPHConnect for Harvard Pilgrim commercial members) to conduct referral and authorization transations, as well as a host of other convenient self-service functions.

Medical Necessity Guidelines

Access our prior authorization policies and medical necessity guidelines for both legacy brands in one convenient spot.

Medical Drug MNGs

Find detailed coverage criteria for medical benefit drugs for Harvard Pilgrim Health Care and Tufts Health Plan.

Vendor Programs

Reference information on our vendor partners who conduct utilization mangement for certain services.


Access pharmacy clinical coverage criteria and medication request forms.

Prior authorization resources

Our prior authorizaiton and notification grids offer a handy overview.

Insights and Updates

Be sure to read our monthly newsletter for updates to policies and procedures.