Tufts Health Public Plans Products

  • Tufts Health Together - MassHealth MCO Plan and Accountable Care Partnership Plans (ACPPs)
  • Tufts Health Direct

Note: The Tufts Health Public Plans Pharmacy Medication Prior Authorization Form by Product provides information on which form to use based on product. Prior to submitting the standard form to Tufts Health Plan, providers should refers to the Tufts Health Plan pharmacy medical necessity guidelines, coverage policies, and member benefits. Providers should also refer to the Tufts Health Direct or Tufts Health Together (MassHealth) Preferred Drug List (PDL) to determine medication coverage and if a drug should be reviewed under medical or pharmacy benefit.

Pharmacy benefit is defined as self administration (i.e., subcutaneous or taken orally) and is filled at retail pharmacies.
Medical benefit is defined as skilled administration (i.e., intravenous, infusion) by medical provider.  

For medication coverage under Pharmacy Benefit, access the standard Medication Prior Authorization Request Form here.

Providers can submit the completed form for pharmacy benefit by:

Fax:   617.673.0988
Mail:  Tufts Health Plan
          705 Mount Auburn Street
          Watertown, MA 02472
          Attn: Pharmacy Utilization Management Department

For medication coverage under Medical Benefit, access the standard Medication Prior Authorization Request Form here.

Providers can submit the completed form for medical benefit by:

Fax:   888.415.9055
Mail:  Tufts Health Plan
          705 Mount Auburn Street
          Watertown, MA 02472
          Attn: Precertification