CommercialPrior AuthHigh impact
Reauthorization requirements for targeted immunomodulators
Harvard Pilgrim Health Care·Dermatology, Rheumatology·Provider Newsletter
Effective date
Jun 30, 2026
We identified it
Jun 20, 2026
Summary
Point32Health (Harvard Pilgrim, Tufts Health Plan, Tufts Health Direct) is requiring reauthorization for existing patients using targeted immunomodulator drugs for dermatological conditions. Current prior authorizations will terminate in two phases: June 30, 2026 for patients on therapy >1 year, and December 31, 2026 for patients completing 1 year of treatment.
Action Required
By June 30, 2026: Submit reauthorization requests via PromptPA for all Point32Health patients using targeted immunomodulators for hidradenitis suppurativa, plaque psoriasis, or psoriatic arthritis who have been on therapy >1 year. Include diagnosis, treatment response, and ongoing need documentation. By December 31, 2026: Submit reauthorizations for remaining patients completing 1 year of therapy. Failure to reauthorize will result in therapy termination and coverage denial.