Point32Health is incorporating a number of updates to our Tufts Health Plan Senior Products drug formularies for the 2027 plan year. These updates are summarized below, along with the Medicare products for which each change applies. For the full list of drugs pertaining to each of the categories outlined below, refer to this document.

Drugs moving to a higher tier (Not applicable to Tufts Health Plan Senior Care Options or Tufts Health One Care)

Effective for fill dates on or after Jan. 1, 2027, certain drugs will be moving to a higher tier. For members currently taking these drugs, current coverage will continue without disruption through Dec. 31, 2026. 

If your patient cannot afford the new copay or coinsurance, please refer to the formulary for potential therapeutic alternatives at lower tiers. If the available alternatives are not clinically appropriate, a tier exception can be requested and will be reviewed in accordance with CMS regulations, as not all drugs are eligible for tier exceptions.  

Drugs subject to quantity limits 

Effective for fill dates on or after Jan. 1, 2027, certain drugs will have quantity limits enforced, which are in line with FDA labeling. 

Drugs newly requiring prior authorization

For fill dates on or after Jan. 1, 2027, certain drugs will require prior authorization.

Drugs moving to non-covered status

Effective for fill dates on or after Jan, 1, 2027, certain drugs will no longer be covered, including drugs with interchangeable generics or therapeutic alternatives.

For members currently taking these drugs, coverage will continue without disruption through Dec. 31, 2026. If you are a prescribing provider and you wish for a member to continue taking a drug on this list, you’ll need to submit a formulary exception request.