Pharmacy Overview
Tufts Health Public Plans
We aim to provide high-quality, cost-effective drug options for your Tufts Health Public Plans patients. We work with providers to make sure we cover the most important and useful drugs for all types of conditions and diseases.
You can find information about our pharmacy program for Tufts Health Together (MassHealth accountable care organization and managed care organization plans), Tufts Health RITogether (RIte Care and Rhody Health Partners) and Tufts Health Direct (a focused-network plan for individuals and small groups) below. You can access a drug interaction checker in the Pharmacy section.
For pharmacy information about Tufts Health Unify (our Medicare-Medicaid One Care plan for people ages 21 – 64), see our Tufts Health Unify pharmacy program page.
Pharmacy Co-Payments
For information about pharmacy co-payments, deductibles and annual out-of-pocket maximums for Tufts Health Together, Tufts Health RITogether and Tufts Health Direct, see our medical benefit summary grids. For information about covered pharmacy supplies and members exempt from pharmacy co-payments, please see Tufts Health Public Plans pharmacy co-payments.
There are no pharmacy co-payments, deductibles, or annual out-of-pocket maximums for Tufts Health Unify. For pharmacy information about Tufts Health Unify, see our Tufts Health Unify pharmacy program.
Preferred Drug List
Our Preferred Drug List (PDL) is a tool to promote appropriate and cost-effective prescription drugs for our members. Refer to our PDL to make sure you prescribe your Tufts Health Public Plans patients drugs we cover. Our Pharmacy and Therapeutics Committee reviews and revises our PDL on a quarterly basis to reflect the committee’s prevailing clinical opinion. Each quarter, we include PDL updates in our online newsletter, Provider Update. To receive an email notification for each new issue of Provider Update, please sign up for email updates.
For more information, please download the plan-specific PDL:
- Tufts Health Together:
- Tufts Health RITogether:
- Tufts Health Direct:
For Tufts Health Unify pharmacy information including our List of Covered Drugs, see our Tufts Health Unify pharmacy program page.
Medication Request Forms
Some drugs require prior authorization. To request a drug authorization for a Tufts Health Public Plans patient, please fax us the appropriate medication request form.
For Tufts Health Together and Tufts Health RITogether, we review requests and make initial determinations regarding prior authorizations within 24 hours of receiving complete medical information. Once we make a decision, we will notify you by fax within the 24-hour period, or by mail if no fax is available.
For Tufts Health Direct, we review requests and make initial determinations regarding prior authorizations within two business days of receiving complete medical information. Once we make a decision, we will notify you by telephone or fax within one business day.
Over-the-counter (OTC) Drug List
Our pharmacy benefit covers select OTC drugs for Tufts Health Together and Tufts Health RITogether members. If your patient needs a covered OTC drug, please write a prescription that your patient can fill at a pharmacy at no cost, or with only a small co-payment.
Additional Information: