CommercialPrior AuthHigh impact
Point32Health medical drug program updates
Harvard Pilgrim Health Care·Oncology, Hematology·Prior Authorization
Effective date
Dec 1, 2025
We identified it
Jun 20, 2026
Summary
Point32Health (Harvard Pilgrim and Tufts Health Plan) is implementing prior authorization requirements for 12 new oncology drugs effective December 1, 2025, and updating restrictions for Vyjuvek wound therapy to prevent concurrent use with other topical treatments.
Action Required
By December 1, 2025: Update billing system to require prior authorization for all listed oncology drugs using HCPCS codes J9999, J3590, and J1599. Train staff to obtain prior authorization through OncoHealth for Harvard Pilgrim Commercial members before administering these medications. For Vyjuvek claims, ensure documentation shows it's not being used concurrently with other topical or gene therapies like Filsuvez or Zevaskyn on the same target wounds. Claims without proper prior authorization will be denied.