How does Tufts Health Plan determine the coverage and tier placement of prescription medications?
Tufts Health Plan makes prescription drug coverage and utilization management decisions based on information provided by the Tufts Health Plan Pharmacy & Therapeutics (P&T) Committee. The P&T Committee is comprised of practicing community-based physicians and pharmacists. The P&T Committee evaluates the safety, efficacy, and cost-effectiveness of medications. Tufts Health Plan frequently evaluates the drug list to see that the most clinically appropriate choices are available to members. We may change a drug’s tier placement during the year. For example, if the patent of a brand name drug expires and the drug becomes available as a generic drug, we may move the brand name drug from Tier-2 to Tier-3 or to the List of Non-covered Drugs with Suggested Alternatives. At the same time, we may place the generic drug on Tier-1.
Related Questions
- What if I need to obtain a prescription or otherwise access health care while I am waiting for the insurance or health plan to re-activate my coverage?
- I use the mail order pharmacy program. How do I transition my existing prescription to the Tufts Health Plan program?
- How does Tufts Health Plan determine the coverage and tier placement of prescription medications?
