CommercialCoverageMedium impact
Pharmacy coverage changes
Harvard Pilgrim Health Care·Dermatology, Gastroenterology, Pediatrics +1 more·Pharmacy
Effective date
Mar 1, 2026
We identified it
Jun 20, 2026
Summary
Point32Health (Harvard Pilgrim and Tufts Health Plan) is implementing pharmacy coverage changes affecting three areas: new drugs will be excluded from formulary coverage starting June 1, 2026, Sucraid will move to non-formulary status with quantity limits on March 1, 2026, and Winlevi will have new coverage criteria under topical acne medications effective April 1, 2026.
Action Required
By March 1, 2026: Update prior authorization processes for Sucraid (sacrosidase) as it moves to non-formulary status with quantity limits. By April 1, 2026: Review new coverage criteria for Winlevi under topical acne medication guidelines. By June 1, 2026: Implement exception request procedures for new-to-market drugs that will be excluded from formulary coverage. All clinical and billing staff should access updated guidelines on Point32Health provider website.