Effective January 1, 2021, the following drugs are the preferred biosimilars for all treatments:
- For Avastin, the preferred products are Mvasi and Zirabev.
- For Rituxan, the preferred products are Ruxience and Truxima.
- For Herceptin, the preferred products are Ogivri and Kanjinti.
These changes impact fully insured, Administrative Services Only (ASO) and our State Health Plan (SHP) members. More information on the Medical Oncology Program and current preferred drug policies can be found on our site.
Actions Required Due to These Changes
Providers with members on impacted drugs should utilize these preferred products before using non-preferred products. Any members who are currently using the brand originator or non-preferred biosimilar drugs should be moved to our preferred products as soon as possible.
Requesting Prior Approval for Medical Oncology
For details on submitting requests for oncology drugs with AIM Oncology, please visit our Medical Oncology Program site. Please note, the prior review code list requires prior authorization through the AIM Provider Portal or by phone at 1-866-455-8414 Monday - Friday, 8 a.m. - 6 p.m. EST. The list is updated on a quarterly basis in the first 10 days of January, April, July and October. If there is no update within this time period, the list will remain unchanged until the following quarter.
Unlisted and miscellaneous health services codes should only be used if a specific code hasn't been established by the American Medical Association.
For information on submitting requests for usage of non-oncology indication drugs, you can view additional policy details on our Prior Plan Review page for Other Services and Procedures.
Medical Policies for Usage of Biosimilars
- Oncologic Uses of Bevacizumab (Avastin®) and Bevacizumab Biosimilars
- Trastuzumab (Herceptin®) and Trastuzumab Biosimilars
- Monoclonal Antibodies for Non-Hodgkin Lymphoma and Acute Myeloid Leukemia In the Non-Hematopoietic Stem Cell Transplant Setting
- Rituximab for the Treatment of Rheumatoid Arthritis
For questions about these preferred products, please call Customer Service. To request prior authorization for one of the preferred products, please contact AIM through the AIM Provider Portal or by phone at 1-866-455-8414 or for use in non-oncology indications, please see Prior Plan Review page for Other Services and Procedures.