Medicare AdvantageCoverageHigh impact
Senior Products: 2026 formulary coverage changes
Harvard Pilgrim Health Care·Pharmacy
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Point32Health is making significant changes to Tufts Medicare plans' drug formularies for 2026, including moving certain drugs to non-covered status, increasing copay tiers for some medications, and adding new prior authorization requirements. Current coverage continues through December 31, 2025, but providers will need to submit exception requests or switch patients to covered alternatives starting January 1, 2026.
Action Required
By December 31, 2025: Clinical staff must review all patients on Tufts Medicare Preferred, Tufts Health Plan Senior Care Options, and Tufts Health One Care plans to identify those taking drugs moving to non-covered status or higher tiers. Submit formulary exception requests for patients who must continue non-covered medications, or work with providers to switch patients to covered therapeutic alternatives. Update prior authorization workflows for Revcovi starting January 1, 2026. Download and review the complete drug lists from pages 1-3 of the referenced formulary changes document.