Requesting authorization for pharmacy and medical drugs

You may request prior authorization for a pharmacy or medical benefit drug in one of the following ways:

PromptPA — With this online tool you can quickly and easily submit requests for pharmacy and medical benefit drugs. View drug-specific criteria, attach clinical information, check the status of your PromptPA request, and receive a response more quickly. Submit your request or view the PromptPA User Guide for more information.
Electronic PA (ePA) — Utilize ePA through EMR, CoverMyMeds (for both pharmacy and medical benefit drugs), or Surescripts (for pharmacy drugs only)
FAX — Submit your request using the corresponding form found below and fax to the number indicated on the form.
Mail prior authorization form to the appropriate Plan:

Harvard Pilgrim Health Care/Tufts Health Plan
Pharmacy Utilization Management Department
1 Wellness Way
Canton, MA 02021-1166

Pharmacy authorization request forms

Harvard Pilgrim Health CareTufts Health Plan

Commercial (including Tufts Health Direct)

Tufts Medicare Preferred, Tufts Health Plan Senior Care Options, Tufts Health One Care

Tufts Health RITogether

Tufts Health Together

Tufts Health Together utilizes MassHealth’s Unified Formulary for pharmacy medications and select medical benefit drugs; for drug coverage and criteria refer to the MassHealth Drug List.

Massachusetts Standard Form for Synagis® Prior Authorization Requests