CommercialPrior AuthHigh impact
Point32Health medical drug program updates
Harvard Pilgrim Health Care·RI · Oncology, Hematology, Infectious Disease +2 more·Prior Authorization
Effective date
Apr 1, 2026
We identified it
Jun 20, 2026
Summary
Point32Health is implementing new prior authorization requirements for multiple high-cost specialty drugs including oncology medications, gene therapies, and biosimilars. The policy also expands coverage criteria for Breyanzi to include marginal zone lymphoma and removes prior auth requirements for HIV PrEP medication Apretude.
Action Required
By April 1, 2026: Billing team must update system to require prior authorization for new specialty drugs including Rybrevant Faspro (J9999), Boncresa and Oziltus (both J3590), Kebilidi (J3590), and Zevaskyn (J3389). Update encounter forms to alert providers of new PA requirements. For Harvard Pilgrim oncology drugs, obtain authorization through OncoHealth portal. For HIV PrEP, remove prior auth requirement for Apretude (J0739) effective March 12, 2026. Claims without proper authorization will be denied.