MedicaidPrior AuthMedium impact
Point32Health medical drug program updates
Harvard Pilgrim Health Care·Dermatology, Genetics, Pediatrics +2 more·Prior Authorization
Effective date
Nov 17, 2025
We identified it
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.
Action Required
By November 17, 2025: Billing 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. Refer to MassHealth Drug List for coverage criteria. For Vyjuvek, ensure prescriber is documented as a specialist or specialist consult notes are provided before submitting claims.