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Harvard Pilgrim Health CareMedicaid · Prior Auth · Prior Authorization · Dermatology, Genetics, Pediatrics +2 moreMedium impact

Point32Health medical drug program updates

Act
by Nov 17, 2025
Effective date
Nov 17, 2025
Identified
Jun 20, 2026

Summary

Point32Health (Harvard Pilgrim and Tufts Health Plan) is implementing new prior authorization requirements for four newly FDA-approved drugs: Zevaskyn, Enflonsia, Qfitlia, and Yeztugo, effective November 17, 2025. Additionally, prior authorization criteria for Vyjuvek are being updated to clarify usage restrictions and prescriber requirements.

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What to do

by Nov 17, 2025 · 3 steps
01Billing team must update prior authorization workflows for new drugs Zevaskyn (J3590), Enflonsia (RSV prevention), Qfitlia (hemophilia), and Yeztugo (HIV PrEP) for Tufts Health Together members.
02Refer to MassHealth Drug List for coverage criteria.
03For Vyjuvek, ensure prescriber is documented as a specialist or specialist consult notes are provided before submitting claims.

Codes mentioned

J3590

Original notice

Point32Health medical drug program updates
point32health.org · Always check the source before changing claims.
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Related changes

See all Harvard Pilgrim Health Care changes →
Point32Health medical drug program updatesMediumEffective Nov 1, 2026 · Prior AuthorizationPoint32Health medical drug program updatesHighEffective Oct 1, 2026 · Prior AuthorizationPoint32Health medical drug program updatesHighEffective Aug 1, 2025 · Provider NewsletterPoint32Health medical drug program updatesHighEffective Dec 1, 2025 · Prior AuthorizationBrowse every Harvard Pilgrim Health Care change in the policy list

Related policy hubs

Harvard Pilgrim Health Care policiesDermatologyGeneticsPediatricsHematologyInfectious DiseaseCode J3590

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