CommercialPrior AuthMedium impact
Point32Health medical drug program updates
Harvard Pilgrim Health Care·Oncology, Ophthalmology·Prior Authorization
Effective date
May 1, 2026
We identified it
Jun 20, 2026
Summary
Point32Health updated prior authorization requirements for three medical drugs: Itvisma now requires prior auth for Tufts Health Together members, Yescarta eligibility expanded for CNS lymphoma patients, and Encelto now requires retina specialist administration. These changes affect oncology and ophthalmology specialties with specific effective dates in May 2026.
Action Required
By May 1, 2026: Update prior authorization workflows for Yescarta (remove CNS lymphoma restrictions), verify Encelto providers are retina specialists, and prepare for Itvisma prior auth requirements effective May 11, 2026. Billing team must update system flags for these drugs and train staff on new criteria. Reference Point32Health Medical Necessity Guidelines and OncoHealth policies for Harvard Pilgrim oncology cases.