Tufts Health Together

The PDL is a tool to promote appropriate and cost-effective prescription drugs for Tufts Health Together members. Providers should refer to the PDL to confirm the drugs being prescribed to patients are covered by Tufts Health Plan. The Pharmacy and Therapeutics Committee reviews and revises the PDL on a monthly basis to reflect the committee’s prevailing clinical opinion. Each quarter, PDL updates are included in Provider Update. To register to receive Provider Update by email, complete the online registration form.

• 2021 Tufts Health Together Accountable Care Organization (ACO) PDF | Searchable List
• 2021 Tufts Health Together Managed Care Organization (MCO) PDF | Searchable List
• MassHealth ACPP/MCO Unified Pharmacy Product List

See the medical benefit summary grids for details about pharmacy copayments, deductibles and annual out-of-pocket maximum amounts for each product.

• Tufts Health Together members pay pharmacy copayments of $3.65 for select covered generic, preferred brand name and over-the-counter (OTC) drugs. Certain covered generic and OTC medications in the following drug classes have a $1 copayment: antihyperglycemics, antihypertensives and antihyperlipidemics.
• When generic drugs are available, Tufts Health Plan may not cover the brand-name drug unless prior authorization is requested and received.
• If Tufts Health Plan approves the brand-name drug, depending on the drug, members may pay a higher copayment. See benefit summary grids for plan-specific cost-share information.

Tufts Health Together members who are exempt from pharmacy copayments:

• Patients younger than 21
• American Indians and Alaskan Natives from federally recognized tribes
• Women who are pregnant or whose pregnancy ended less than 60 days prior
• Patients in nursing facilities, immediate-care facilities for the developmentally delayed, or hospitals serving patients with acute, chronic-disease, or rehabilitation needs
• Patients in hospice care
• Patients who have reached their pharmacy copayment cap for the calendar year
• Patients identified by MassHealth whose income is less than 50% of the Federal Poverty Level

Additional products covered with a prescription at no cost share:

• Family-planning drugs and supplies
• Humidifiers and vaporizers
• Peak flow meters and spacers, for patients with asthma
• Blood glucose meters and test strips for patients with diabetes

Some drugs require prior authorization. To request a drug authorization for a Tufts Health Public Plans patient, fax the appropriate medication request form.

For Tufts Health Together members, requests are reviewed and initial determinations regarding prior authorizations are made within 24 hours of receiving complete medical information. Once a decision is made, Tufts Health Plan will notify providers by fax within the 24-hour period, or by mail if no fax is available.

Visit the Pharmacy Updates page to find monthly pharmacy updates for Tufts Health Public Plans members.

• Specialty Pharmacy Program
• OTC Drug List
• Voluntary 90-Day Supply Pharmacy Program