Increase Treatment Options with Biosimilar Medications
Date: 09/02/20
Biosimilar medications are Food and Drug Administration (FDA)-approved, safe and effective medicines that are highly similar to existing biologic medicines. Biosimilars are like generics, but are not considered true generics. The FDA regulates biosimilar manufacturing to ensure they scientifically demonstrate safety, purity, potency, and effectiveness while showing no clinically meaning differences.
The FDA has approved 25+ biosimilar medications, however only certain biosimilars are actually available on the market. As health-care expenditures rise, biosimilar drugs represent a clear opportunity to reduce health-care costs while maintaining patient access to vital therapies.
Superior HealthPlan is moving towards preferring biosimilars over the reference products to increase access and treatment options for members. Below is a list of available biosimilars on the US market and its reference medication.
Reference Medication | Biosimilar Medication |
|---|---|
Neupogen | Granix Zarxio Nivestym |
Neulasta | Fulphila Nyvepria Udenyca Ziextenzo |
Aranesp | Retacrit |
Epogen/Procrit | Retacrit |
Remicade | Avsola Inflectra Renflexis |
Avastin | Mvasi Zirabev |
Rituxan | Ruxience Truxima |
Herceptin | Herzuma Kanjinti Ogrivi Otruzant Trazimera |
Superior requires prior authorization for certain Clinician-Administered Drugs (CADs), which includes biosimilar medications, provided to Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) and CHIP members.
Effective June 1, 2020, biosimilar medications no longer require prior authorization. Please reference the table below for changes to prior authorization requirements:
HCPCS CODE | DESCRIPTION | PRIOR AUTHORIZATION REQUIREMENTS |
|---|---|---|
J1447 | INJECTION TBO-FILGRASTIM 1 MCG (GRANIX) | No PA required for participating providers. |
Q5110 | INJ FILGRASTIM-AAFI BIOSIMILR 1 MCG | No PA required for participating providers. |
Q5108 | INJ PEGFLGRSTM-JMDB BIOSIMLR 0.5 MG (FULPHILA) | No PA required for participating providers. |
Q5111 | INJECTION, PEGFILGRASTIM-CBQV, BIOSIMILAR, 0.5 MG (UDENYCA) | No PA required for participating providers. |
Q5107 | INJECTION BEVACIZUMAB-AWWB BIOSIMILAR 10 MG (MVASI) | No PA required for participating providers. |
Q5114 | INJECTION TRASTUZUMAB-DKST BIOSIMILAR 10 MG (OGRIVI) | No PA required for participating providers. |
Q5117 | INJECTION TRASTUZUMAB-ANNS BIOSIMILAR 10 MG (KANJINTI) | No PA required for participating providers. |
Effective, July 1, 2020, the following changes to prior authorization requirements for biosimilar medications went into effect:
HCPCS CODE | DESCRIPTION | PRIOR AUTHORIZATION REQUIREMENTS |
|---|---|---|
J1442 | INJ FILGRASTIM EXCL BIOSIMILAR (NEUPOGEN) | PA required for all providers |
J2505 | INJECTION, PEGFILGRASTIM, 6 MG (NEULASTA) | PA required for all providers |
J0881 | INJECTION DARBEPOETIN ALFA 1 MICROGRAM NON-ESRD USE (ARANESP) | PA required for all providers |
J0882 | INJECTION DARBEPOETIN ALFA 1 MICROGRAM FOR ESRD ON DIALYSIS (ARANESP) | PA required for all providers |
J0885 | INJECTION EPOETIN ALFA FOR NON-ESRD USE 1000 UNITS (EPOGEN/PROCRIT) | PA required for all providers |
J9035 | INJECTION BEVACIZUMAB 10 MG (AVASTIN) | PA required for all providers except ophthalmologists |
J9355 | INJECTION TRASTUZUMAB EXCLUDES BIOSIMILAR 10 MG (HERCEPTIN) | PA required for all providers |
For additional information on biosimilar medications, please reference the following materials found on Superior's Pharmacy webpage, under Pharmacy Resources:
- Biosimilar Alternatives for Commonly Prescribed Biologics
- Biosimilars - Understanding the Safety and Efficacy
- Biosimilars - Switching from a Reference Biological
For questions, please contact Superior’s Pharmacy Department 1-800-218-7508, ext. 22080.