Look up your medication on your plan's drug list
For coverage dates starting 01/01/2021, please refer to the following links:
Check whether any of the terms below apply to your prescription
If one or more of the terms apply, take the following steps:
PA: Prior Authorization
Some drugs must meet certain criteria before they’re covered. If your provider believes a drug with a prior authorization is necessary for your treatment, the provider should submit a request for coverage by faxing a Universal Pharmacy Medical Review Request Form to Tufts Health Freedom Plan. The form is available at thfp.com in the Provider a Resource Center. If the drug meets our medical necessity coverage guidelines, your request will be approved, and we will cover the drug. If for some reason it is not approved, you always have the option of appealing the decision.
STPA: Step Therapy Prior Authorization
You may be required to try a certain drug to treat a specific medical condition before Tufts Health Freedom Plan will approve the coverage of another drug to treat the same condition. If you have not previously taken the steps required by our pharmacy coverage guidelines, and your provider believes the drug prescribed for you is medically necessary, he or she may submit a request for coverage by faxing a Universal Pharmacy Medical Review Request Form. If you are a new member, please call us and let us know if you are currently taking a step therapy drug from another plan.
NTM: New-To-Market Drug Evaluation
In an effort to ensure the new-to-market prescriptions we cover are safe, effective and affordable, we delay coverage of many new drug products until our Pharmacy and Therapeutics (P&T) Committee and physician specialist review them. These drugs require prior authorization.
QL: Quantity Limitation
There may be a limit on how much of a drug you can get for a specific time period. You’re covered for up to the quantity posted in our list of covered drugs. If your provider believes it’s necessary for you to take more than the quantity limit posted on the list, he or she may submit a Universal Pharmacy Medical Review Request Form to request coverage.
SP: Designated Specialty Pharmacy
We’ve designated special pharmacies to supply a select number of medications used in the treatment of complex disease states. These pharmacies specialize in providing these medications and are staffed with nurses, coordinators and pharmacists to provide support services for members. Call the designated specialty pharmacy provider indicated in your search results of covered drugs, or contact the Tufts Health Freedom Plan Member Services Department at the number on your ID card. We want to make sure you receive your covered drug without interruption.
There are thousands of drugs listed on the Tufts Health Freedom Plan covered drugs lists. In fact, most drugs are covered. There is, however, a list of drugs that Tufts Health Freedom Plan currently does not cover. In many cases, these drugs are not covered by Tufts Health Freedom Plan because there are safe, comparably effective, and cost-effective alternatives available. Our goal is to keep pharmacy benefits as affordable as possible.
If your provider believes a non-covered drug is necessary for your treatment, he or she may submit a request for coverage by faxing a Universal Pharmacy Medical Review Request Form. If the drug meets our medical necessity coverage guidelines, your request will be approved, and we will cover the drug. If it is not approved, you always have the option of appealing the decision.