Plan Documentation
Medicare Advantage HMO Plans
Tufts Health Plan Medicare Preferred HMO member cards look like the samples below:
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Prescription (Rx) Drug & Pharmacy
HMO Employer Group Plans Pharmacy Locator
Use the link below to determine if a pharmacy is within the preferred pharmacy network. Click here to access the 2026 HMO Employer Group Plans Pharmacy Locator.
HMO Pharmacy Locator
Use the link below to determine if a pharmacy is within the preferred pharmacy network. Click here to access the 2026 HMO Pharmacy Locator.
Medicare Prescription Payment Plan Fact Sheet
This fact sheet outlines information regarding the Medicare Prescription Payment Plan which is a new payment option in the prescription drug law that works with your current drug coverage to help you manage your out-of-pocket Medicare Part D drug costs by spreading them across the calendar year (January-December). Starting in 2025, anyone with a Medicare drug plan or Medicare health plan with drug coverage (like a Medicare Advantage Plan with drug coverage) can use this payment option. All plans offer this payment option and participation is voluntary. This payment option might help you manage your expenses, but it doesn’t save you money or lower your drug costs.
Part D Late Enrollment Penalty (LEP) Right to Review Reconsideration Notice
This document allows you to learn about your right to ask Medicare to review your Medicare Part D late enrollment penalty.
Tufts Health Plan Medicare Preferred HMO Employer Group Formulary (List of Covered Drugs)
This document is a comprehensive formulary containing the prescription drugs covered by Tufts Health Plan Medicare Preferred Medicare Advantage HMO Group Plans.
Tufts Health Plan Medicare Preferred HMO Individual Formulary (List of Covered Drugs)
This document is a comprehensive formulary containing the prescription drugs covered by Tufts Health Plan Medicare Preferred Medicare Preferred individual HMO plans.
Tufts Health Plan Medicare Preferred HMO Transition Process
This document details what to do if your current prescription drugs are not included in the Tufts Health Plan Medicare Preferred formulary, or drug list, or are restricted in some way.
Tufts Health Plan Medicare Preferred Prior Authorization Medical Necessity Guidelines
This document details the Tufts Health Plan Medicare Preferred Medical Necessity Guidelines. These guidelines are used by Tufts Health Plan to determine medical necessity and appropriateness of health care services for the purpose of determining coverage under the applicable health benefit plan.
Tufts Health Plan Medicare Preferred Step Therapy Prior Authorization Medical Necessity Guidelines
This document details drugs that may require prior authorization or Step Therapy to be covered by Tufts Health Plan Medicare Preferred Medicare Advantage Plans. Prior Authorization means that your doctor, or prescriber, must first show that you have a medically necessary need for the drug before Tufts Health Plan will cover the drug cost. Step Therapy is a type of prior authorization that in most cases requires a less expensive drug, that has been proven effective for your condition, is prescribed before moving up a "step" to a more expensive drug.
PPO Access Plan
Tufts Health Plan Medicare PPO Access member cards look like the sample below:
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Prescription (Rx) Drug & Pharmacy
Medicare Prescription Payment Plan Fact Sheet
This fact sheet outlines information regarding the Medicare Prescription Payment Plan which is a new payment option in the prescription drug law that works with your current drug coverage to help you manage your out-of-pocket Medicare Part D drug costs by spreading them across the calendar year (January-December). Starting in 2025, anyone with a Medicare drug plan or Medicare health plan with drug coverage (like a Medicare Advantage Plan with drug coverage) can use this payment option. All plans offer this payment option and participation is voluntary. This payment option might help you manage your expenses, but it doesn’t save you money or lower your drug costs.
PPO Pharmacy Locator
Use the link below to determine if a pharmacy is within the preferred pharmacy network. Click here to access the 2026 PPO Pharmacy Locator.
Tufts Health Plan Medicare Preferred Access (PPO) Formulary (List of Covered Drugs)
This document is a comprehensive formulary containing the prescription drugs covered by Tufts Health Plan Medicare Preferred Medicare Preferred Access (PPO) plan.
Tufts Health Plan Medicare Preferred Prior Authorization Medical Necessity Guidelines
This document details the Tufts Health Plan Medicare Preferred Medical Necessity Guidelines. These guidelines are used by Tufts Health Plan to determine medical necessity and appropriateness of health care services for the purpose of determining coverage under the applicable health benefit plan.
Tufts Health Plan Medicare Preferred Step Therapy Prior Authorization Medical Necessity Guidelines
This document details drugs that may require prior authorization or Step Therapy to be covered by Tufts Health Plan Medicare Preferred Medicare Advantage Plans. Prior Authorization means that your doctor, or prescriber, must first show that you have a medically necessary need for the drug before Tufts Health Plan will cover the drug cost. Step Therapy is a type of prior authorization that in most cases requires a less expensive drug, that has been proven effective for your condition, is prescribed before moving up a "step" to a more expensive drug.
Medicare Supplement Plans
Tufts Medicare Preferred Supplement member cards look like the sample below:
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Tufts Health Plan Senior Care Options (D-SNP)
Tufts Health Plan Senior Care Options member cards look like the samples below:
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Prescription (Rx) Drug & Pharmacy
MassHealth Over-the-Counter Drug List
This document lists the only over-the-counter (OTC) drugs that are covered by MassHealth without prior authorization (PA).
Senior Care Options (D-SNP) Pharmacy Locator
Use the link below to determine if a pharmacy is within the preferred pharmacy network. Click here to access the 2026 Senior Care Options (D-SNP) Pharmacy Locator.
Tufts Health Plan Senior Care Options (D-SNP) Formulary (List of Covered Drugs)
This document is a comprehensive formulary containing the prescription drugs covered by Tufts Health Plan Senior Care Options plan.
Tufts Health Plan Senior Care Options (D-SNP) Prior Authorization Medical Necessity Guidelines
This document details the Tufts Health Plan Senior Care Options Medical Necessity Guidelines. These guidelines are used by Tufts Health Plan to determine medical necessity and appropriateness of health care services for the purpose of determining coverage under the applicable health benefit plan.
Tufts Health Plan Senior Care Options (D-SNP) Step Therapy Prior Authorization Medical Necessity Guidelines
This document details drugs that may require prior authorization or Step Therapy to be covered by the Tufts Health Plan Senior Care Options Plan. Prior Authorization means that your doctor, or prescriber, must first show that you have a medically necessary need for the drug before Tufts Health Plan will cover the drug cost. Step Therapy is a type of prior authorization that in most cases requires a less expensive drug, that has been proven effective for your condition, is prescribed before moving up a "step" to a more expensive drug.
Tufts Health Plan Senior Care Options (HMO-SNP) Transition Process
This document details certain circumstances in which the plan can offer a temporary supply of a drug when your drug is not included in the Tufts Health Plan Senior Care Options formulary, or drug list, or is restricted in some way.
Tufts Health One Care (D-SNP)
Tufts Health One Care member cards look like the samples below:
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Prescription (Rx) Drug & Pharmacy
One Care (D-SNP) Pharmacy Locator
Use the link below to determine if a pharmacy is within the preferred pharmacy network. Click here to access the 2026 One Care (D-SNP) Pharmacy Locator.
Tufts Health One Care (D-SNP) Plan Formulary (List of Covered Drugs)
This document is a comprehensive formulary containing the prescription drugs covered by the Tufts Health One Care plan.
Tufts Health One Care (D-SNP) Prior Authorization Medical Necessity Guidelines
This document details the Tufts Health One Care Medical Necessity Guidelines. These guidelines are used by Tufts Health Plan to determine medical necessity and appropriateness of health care services for the purpose of determining coverage under the applicable health benefit plan.
Tufts Health One Care (D-SNP) Step Therapy Prior Authorization Medical Necessity Guidelines
This document details drugs that may require prior authorization or Step Therapy to be covered by the Tufts Health One Care Plan. Prior Authorization means that your doctor, or prescriber, must first show that you have a medically necessary need for the drug before Tufts Health Plan will cover the drug cost. Step Therapy is a type of prior authorization that in most cases requires a less expensive drug, that has been proven effective for your condition, is prescribed before moving up a "step" to a more expensive drug.
Use Opioids Safely
Tufts Health One Care (a Medicare-Medicaid plan) would like to let you know the importance of using opioids safely, alternate options to opioids, and the signs of an overdose