CommercialCoverageMedium impact
New for 2026: Select formulary
Harvard Pilgrim Health Care·MA, NH, ME, RI · Pharmacy, Endocrinology, Bariatric Surgery·Pharmacy
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Point32Health is implementing a new Select formulary for Harvard Pilgrim Health Care large group products starting January 1, 2026, which excludes all weight loss medication coverage and is designed for cost containment. This affects large group commercial plans in MA, NH, ME, and RI, with members being notified before their coverage changes.
Action Required
Before January 1, 2026: Billing team must review the new Select formulary available at the Point32Health provider portal to understand covered medications. Update prior authorization processes for weight loss medications as these will no longer be covered under the Select formulary for Harvard Pilgrim large group members. Verify patient formulary type before prescribing or billing for pharmacy services to avoid claim denials.