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Searchable Drug List Pharmacy Updates

Pharmacy forms changes

Tufts Health Public Plans forms for pharmacy requests requiring prior authorization have been updated.

Preferred Drug List changes effective January 1, 2016

  • Products included on the medical benefit but not covered on the pharmacy benefit
  • Products with new prior authorization
  • Products noncovered
  • Categories subject to step therapy
  • Products with changes in criteria

Searchable Drug List Member Care

HEDIS: Preventive screening for adult and adolescent women

On an annual basis, we evaluate preventive screenings and immunizations for our members who are women.

Searchable Drug List Reminders

Did you know ...

For the most current pharmacy benefit information, including tier changes, online formularies, and descriptions of pharmacy management programs, visit the Pharmacy section of our website. Also visit for other important business information such as updates to our Quality Improvement Program and progress to meeting goals, disease management programs, Clinical Practice Guidelines, Utilization Management Criteria/Guidelines, and Members’ Rights and Responsibilities.

Postpartum visits and postpartum depression screening

If you know that your patient has recently given birth, please find out whether or not she has received a postpartum visit and postpartum depression screening. It is important to encourage new mothers to schedule and attend postpartum visits within the vital time frame after delivery.

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Searchable Drug List What's New

Changes to medical necessity and coverage guidelines

Effective January 1, 2016, changes to certain guidelines will apply to your Tufts Health Together and Tufts Health Direct patients.

Coverage of applied behavioral analysis (ABA) services

Effective October 1, 2015, Tufts Health Public Plans will cover applied behavioral analysis (ABA) services to Tufts Health Together members under 21 years of age. Children with autism under 21 years of age will be eligible to receive this service with prior authorization.

Doula By My Side program

Tufts Health Public Plans members will have access to prenatal services through a new program with the Pettaway Pursuit Foundation (PPF).

Drugs and biological agents effective January 1, 2016

On claims processed with a date of service on or after January 1, 2016, we will be instituting additional payment coding edits for various drugs and biological agents.

Durable medical equipment effective January 1, 2016

Beginning with claims processed on or after January 1, 2016, Tufts Health Public Plans will implement modifications to our durable medical equipment (DME), orthotic, prosthetic, and supply coding edits to reflect nationally and regionally accepted standards.

NCQA ratings

National Committee for Quality Assurance’s (NCQA) Health Insurance Plan Ratings 2015 – 2016 have been released.

Our name has changed

We are pleased and proud to share that as of October 2015, we will become known by one name: Tufts Health Plan. This change of name, from Tufts Health Plan – Network Health to Tufts Health Plan, reflects our ongoing assimilation into the Tufts Health Plan family.

Proposed nondiscrimination rule

On September 3, 2015, the U.S. Department of Health and Human Services Office of Civil Rights released a proposed rule on nondiscrimination under Section 1557 of the Affordable Care Act (ACA). Section 1557 is the civil rights provision of the ACA. Section 1557 is the civil rights provision of the ACA.

Spinal conditions management program effective December 1, 2015

Effective December 1, 2015, Tufts Health Public Plans will implement changes to our prior authorization program for the management of spinal conditions, including spine surgery and interventional pain management procedures.

Tufts Health Public Plans Provider Update is our quarterly publication of updates relevant to our Tufts Health Public Plans provider network and serves to amend our Tufts Health Public Plans Provider Manual.