Biosimilars preferred over Herceptin, Avastin and Rituxan, effective July 1

Beginning July 1, 2020, we’ll be preferring lower cost biosimilar products over Herceptin® (trastuzumab), Avastin® (bevacizumab) and Rituxan® (rituximab) when used for the treatment of cancer(s) for patients who are new to therapy. This change impacts all product lines, including commercial group, individual, Medicaid and Medicare.

Why we’re making this change

Our Pharmacy and Therapeutics Committee (comprised of network physicians) monitors the availability of new biosimilars, which have been proven to have no meaningful difference in safety, purity or effectiveness for our members and can help them save on out-of-pocket costs.

Preferred biosimilar products and billable codes

A list of preferred biosimilars and billable codes is included below.

Non-preferred brand products
(No new starts after July 1, 2020)
Preferred biosimilars as of July 1, 2020
  • Avastin (bevacizumab)
    HCPCS Code J9035
  • Mvasi (bevacizumab-awwb)
    HCPCS Code Q5107
  • Zirabev (bevacizumab-bvzr)
    HCPCS Code Q5118
  • Herceptin (trastuzumab)
    HCPCS Code J9355
  • Herceptin Hylecta (trastuzumab and hyaluronidase-oysk)
    HCPCS Code J9356
  • Kanjinti (trastuzumab-anns)
    HCPCS Code Q5117
  • Trazimera (trastuzumab-qyyp)
    HCPCS Code Q5116
  • Rituxan (rituximab)
    HCPCS Code J9312
  • Rituxan Hycela (rituximab and hyaluronidase)
    HCPCS Code J9311
  • Ruxience (rituximab-pvvr)
    HCPCS Code J3490
  • Truxima (rituximab-abbs)
    HCPCS Code Q5115

Prior authorizations

Herceptin and Avastin do not currently require prior authorization. Therefore, their preferred biosimilars will not require prior authorization. Although Rituxan currently has a prior authorization requirement, we are removing the prior authorization for Rituxan biosimilars for individual, commercial group and Medicaid. At this time, we’re not removing prior authorization for Rituxan or Rituxan biosimilars for Medicare.

For patients currently on Herceptin, Avastin or Rituxan

This change will impact new starts only. Members currently receiving treatment using a non-preferred product will be able to continue their treatment.

Members receiving Avastin for the treatment of ocular disorders will not be required to use preferred biosimilars. Providers should be using a different code to indicate its use for treating ocular disorders. If a provider incorrectly bills for treatment of ocular disorders using the cancer code (J9035), the code will be denied.