2023 Pharmacy Program

For the latest information on our pharmacy program including our 2023 prescription drug formularies as well as our medical benefit drug necessity guidelines, please visit our website. As a reminder, our guidelines and formularies are reviewed and updated regularly, and new and updated criteria are available to reference online.

Online Prior Authorizations Now Available
You now have access to a new online prior authorization tool, PromptPA, for both pharmacy and medical benefit drugs prior authorization requests. PromptPA can be accessed through our Provider Portal or directly at https://point32health.promptpa.com/. Online submission enables you to view drug-specific criteria, attach clinical information, check the status of your request, and receive a response more quickly.

We also encourage the use of electronic prior authorization (ePA) through EMR, CoverMyMeds, or Surescripts. Alternatively, you can fax prior authorization requests using our updated request forms to 617-673-0956.

With the new year, please remember to always verify member benefits and eligibility prior to the service. You can verify eligibility on our provider portal. Additionally, the member ID card includes important information such as member cost share and billing instructions, including pharmacy claims information for OptumRx, our pharmacy benefit manager as of Jan. 1, 2023.