Effective for fill dates on or after Jan. 1, 2024, Point32Health is making some updates to unify our medical oncology biosimilar strategy across product lines, and we want to provide you with a breakdown of what the preferred products will be for the bevacizumab, rituximab, and trastuzumab drug classes. As a reminder, all non-preferred oncology biosimilars will require prior authorization.
Bevacizumab drug class
Our medical oncology biosimilar strategy for the bevacizumab drug class is not changing for any of our Harvard Pilgrim or Tufts Health Plan products. As is the case today, Mvasi and Zirabev will continue to be the preferred products in this class. All other bevacizumab products will be considered non-preferred, and will require prior authorization.
Rituximab drug class
Currently, the preferred rituximab biosimilars for Harvard Pilgrim commercial, Tufts Health Plan commercial, and Tufts Health Direct are Ruxience and Truxima. For Tufts Health Together and Tufts Health RITogether, the current preferred biosimilars are Riabni, Ruxience, and Truxima.
As of Jan. 1, while Tufts Health Together and Tufts Health RITogether will see a change, the other products mentioned will not; Point32Health’s preferred rituximab biosimilars will be Ruxience and Truxima.
Trastuzumab drug class
Today, the preferred trastuzumab biosimilars for Harvard Pilgrim commercial, Tufts Health Plan commercial, and Tufts Health Direct are Kanjinti, Trazimera and Ogivri.
The current preferred biosimilars for Tufts Health Together and Tufts Health RITogether are Herzuma, Ontruzant, Trazimera, Kanjinti, and Ogivri.
Beginning Jan. 1, the preferred trastuzumab biosimilars for all aforementioned products will be Kanjinti and Trazimera.
For complete details, including information about medical oncology biosimilar strategies and any other updates for Jan. 1, please refer to the following Medical Necessity Guidelines:
- Tufts Health Plan Bevacizumab
- Tufts Health Plan Trastuzumab
- Tufts Health Plan Rituximab (commercial, Tufts Health Direct)
- Tufts Health Plan Rituximab (Tufts Health Together, Tufts Health RITogether)
- For Harvard Pilgrim’s commercial clinical criteria for Bevacizumab, Trastuzumab, and Rituxan products, refer to the Harvard Pilgrim Prior Authorization Policies page on OncoHealth’s website.
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