Tufts Health Direct
We aim to provide high-quality, cost-effective drug options for your employees. We work with providers and pharmacists to make sure we cover the most important and useful drugs for all types of conditions and diseases.
Containing costs while maintaining quality — our Pharmacy Management programs
We continue to develop pharmacy management programs to help manage the rising cost of drugs, while working for the needs of the member. Our Pharmacy and Therapeutics (P&T) Committee includes doctors and pharmacists from the community, along with members of Tufts Health Plan's clinical staff, who meet regularly to review drug data and studies in order to make clinical recommendations.
3-Tier Pharmacy Copayment Program for Tufts Health Direct
To help maintain flexibility in the pharmacy benefit, we encourage the use of cost-effective medications and preferred brand names through the 3-tier copayment program. This allows us to leave prescribing decisions to physicians.
- Tier-1: lowest copayment; includes most generic drugs
- Tier-2: middle level copayment; primarily includes selected cost-effective brand name drugs
- Tier-3: highest copayment; includes non-preferred formulary drugs, formulary drugs not selected for Tier-2, and all covered non-formulary drugs
There may be instances when only a Tier-3 drug is appropriate, however, a vast majority of the higher-priced Tier-3 drugs have lower cost alternatives on Tier-1 or Tier-2.
If a physician prescribes a Tier-3 or Tier-2 drug, the member can work with him or her to determine if there is an appropriate drug available that will be less costly. Please note that tier placement is subject to change throughout the year.
Depending on the plan chosen, coverage for prescription drugs may be subject to an annual deductible amount or be limited to our generic-focused formulary.
Helping members navigate pharmacy benefits
We understand that dealing with pharmacy coverage can be confusing for your employees. That's why we've made it easy for them to gather information, check benefits, review claims, and even order prescriptions online.
OptumRx, Tufts Health Plan's pharmacy benefit manager, provides information about prescription coverage and allows members to view drugs by tier level, therapeutic class, or alphabetical order. Search our drug list: