CommercialCoverageMedium impact
Pharmacy coverage changes
Harvard Pilgrim Health Care·Family Medicine, Internal Medicine, Cardiology +4 more·Pharmacy
Effective date
Aug 1, 2026
We identified it
Jun 20, 2026
Summary
Multiple drug formulary changes effective August 1, 2026, affecting Harvard Pilgrim, Tufts Health Plan Commercial, and Tufts Health RITogether plans. Several medications are moving to non-formulary status requiring medical necessity documentation, and Tryngolza will have more stringent exception criteria.
Action Required
By July 31, 2026: Update prior authorization workflows for Tryngolza, Cefixime oral suspension, Entresto Sprinkle oral capsule, and Xuriden. Providers must document inadequate response to Xyrem before prescribing Lumryz or Xywav for narcolepsy. Update prescription systems to flag these medications as requiring medical necessity documentation for Harvard Pilgrim and Tufts plans. Train clinical staff on new sodium oxybate step therapy requirements.