What are Tufts Health Plans Pharmacy Management Programs?
Medical Review Process (applies to all programs below) For all of the following pharmacy management programs, if a prescribing physician feels a particular drug is needed for one of our members, the physician may request coverage by submitting a request for coverage under our medical review process. New-to-Market Drug Evaluation Process In an effort to make sure the new-to-market prescriptions we cover are safe, effective and affordable, we delay coverage of many new drug products until our P&T Committee and physician specialists have reviewed them. Non-Covered Drugs with Suggested Alternatives (NC): A small number of drugs (less than 1%) are not covered by Tufts Health Plan because our P&T Committee and physician specialists have determined that there are safe, effective, and more affordable alternatives available. Drugs Requiring Prior Authorization (PA): To promote safety for everyone, Tufts Health Plan requires Prior Authorization for certain drugs. We work with physicians to see t
