25-374m Biosimilar Medications Are Preferred - 2nd Quarter
Date: 05/01/25
Stay informed about the latest preferred biosimilar products
Biosimilars are medicines approved by the U.S. Food and Drug Administration (FDA) that work the same way as existing biologic medicines. The FDA closely monitors how biosimilars are made to ensure they are safe, effective and have no clinically meaningful differences from the original medicine. Biosimilars also cost less than brand name versions, which can help reduce overall health care costs while still providing high-quality care.
Preferred biosimilar medications
Starting September 1, 2020, Health Net, on behalf of CalViva Health, began preferring certain biosimilar medications instead of their brand name versions (or reference products) for Medi-Cal members. For those who have not tried a biosimilar, the patient must try and fail (or have a contraindication to) the preferred biosimilar(s) before the brand name or reference product will be approved. The table below lists brand medications and their preferred biosimilars. Pharmacy prior authorization guidelines can be found on the provider website at Drug Coverage Policies.
Reference/Nonpreferred | Preferred |
|---|---|
Bevacizumab agents (Alymsys®, Avastin®, Avzivi®, Vegzelma®)1 | Mvasi®, Zirabev™ |
Erythropoiesis-stimulating agents (Aranesp®, Epogen®, Mircera®, Procrit®) | Retacrit®3 |
Filgrastim agents (Granix®, Neupogen®, Nypozi™, Releuko®) | Zarxio®3 followed by Nivestym® |
Infliximab agents (Remicade®, Zymfentra®)2 | Infliximab, Inflectra®, Renflexis®, Avsola® |
Pegfilgrastim agents (Fulphila®, Fylnetra®, Neulasta®, Neulasta Onpro®, Rolvedon®, Ryzenuta™, Stimufend®, Ziextenzo™) | Udenyca®, Udenyca Onbody, Nyvepria™ |
Rituximab agents (Riabni®, Rituxan®, Rituxan Hycela®) | Ruxience®4, Truxima®4 |
Trastuzumab agents (Herceptin®, Herceptin Hylecta™, Hercessi™, Herzuma®, Ontruzant®) | Kanjinti®, Ogivri®, Trazimera™ |
1 Only applies to non-ophthalmology.
2 Avsola preferred for Health Net Medi-Cal.
· Preferred biosimilars are required in lieu of branded drugs.
· Must try all preferred products. Please refer to the drug-specific policy for complete list of preferred products.
· Unbranded infliximab (NDC 57894-0160-01) is required prior to branded Remicade.
3 No prior authorization required under medical benefit.
4 No prior authorization required for oncology/hematology.
This information applies to Physicians and Participating Physician Groups (PPGs).
This information applies to Medi-Cal in Fresno, Kings and Madera counties.