Pharmacy Coverage Decision

A coverage decision about your drugs is a decision about your benefits and covered drugs or the amount we will pay for your drugs. This applies to your Part D drugs, MassHealth prescription drugs and MassHealth over-the-counter drugs.

You may request a coverage decision if you:

  • Need a drug that is not on our List of Covered Drugs (2022) (PDF) 
  • Have been using a drug that was previously included on our List of Covered Drugs, but is being removed or was removed from this list during the plan year
  • Need prior authorization for a drug your doctor has prescribed
  • Want to request an exception to the requirement that you try another drug before you get a drug your doctor prescribed
  • Want to request an exception to the limit on the number of pills (quantity limit) you can receive so that you can get the number of pills your doctor prescribed
  • Want to be reimbursed for a covered prescription drug that you paid for out of pocket

Questions about your prescription coverage: 


Tufts Health Unify is a health plan that contracts with both Medicare and MassHealth to provide benefits of both programs to enrollees under the One Care program.

Benefits, the List of Covered Drugs and pharmacy and provider networks may change from time to time throughout the year and on Jan. 1 of each year.

Limitations and restrictions may apply. For more information, call Tufts Health Unify member services toll-free at 855-393-3154 (TTY: 711).

H7419_4520_CMS Approved
Page modified on: 12/29/2017 5:06:24 PM