Changes to our preferred biosimilars for pegfilgrastim effective April 1
Beginning Apr. 1, 2021, we’ll be preferring certain pegfilgrastim products used to help make white blood cells and reduce infections after receiving cancer medications. This change impacts all current users in all product lines (less than 50 members), including commercial group, individual, Medicaid and Medicare. Medicare members currently receiving treatment using a non-preferred product will be able to continue their treatment.
What’s changing?
Effective April 1, we’ll no longer be covering Udenyca (pegfilgrastim-cbqv) and Ziextenzo (pegfilgrastim-bmez), and instead moving to our preferred pegfilgrastim products as of July 1, 2020 (see chart below).
Preferred pegfilgrastim products and billable codes
| Non-preferred pegfilgrastim products (coverage ending 4/1/21) | Preferred pegfilgrastim products as of April 1, 2021 |
|---|---|
Udenyca (pegfilgrastim-cbqv)
|
Neulasta and Neulasta OnPro (pegfilgrastim)
|
|
Ziextenzo (pegfilgrastim-bmez)
|
Fulphila (pegfilgrastim-jmdb)
|
|
Nyvepria (pegfilgrastim-apgf)
|
Prior authorizations
Preferred pegfilgrastim products do not require prior authorization at this time.
Why are we 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.
What do you need to do?
Members receiving active treatment on non-preferred pegfilgrastim products will need to be switched to preferred pegfilgrastim products. Medicare members currently receiving treatment using a non-preferred product will be able to continue their treatment. Thank you for your continued partnership.