Pharmacy Coverage Changes

Tufts Medicare Preferred HMO, Tufts Medicare Preferred PDP, Tufts Health Plan SCO, Tufts Health Unify

October 30, 2020  

Noncovered Drugs

Effective for fill dates on or after January 1, 2021, Tufts Health Plan will no longer cover several drugs for Tufts Health Medicare Preferred HMO, Tufts Medicare Preferred PDP, Tufts Health Plan SCO and Tufts Health Unify, including those drugs with interchangeable generics or therapeutic alternatives. For members currently taking these drugs, coverage will continue without disruption through December 31, 2020. For a member to continue taking one of these noncovered drugs, the prescribing provider must submit a formulary exception request.

Drugs Status Changes

Effective for fill dates on or after January 1, 2021, several drugs will be moving tiers for Tufts Medicare Preferred HMO and Tufts Medicare Preferred PDP. For members currently taking these drugs, coverage will continue without disruption through December 31, 2020. If your patient cannot afford the new copayment, refer to the formulary for potential therapeutic alternatives at lower tiers. If the available alternatives are not clinically appropriate, a tier exception can be requested and will be reviewed in accordance with CMS regulations, as not all drugs are eligible for tier exceptions.