Updates to Blue Cross NC preferred Injectable Oncology Program policy and White Blood Cell Growth Factor policy, effective April 1, 2024

Effective April 1, 2024, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will be updating our preferred Injectable Oncology Program policy and White Blood Cell Growth Factor policy.

Preferred Injectable Oncology Program policy

We are updating our preferred trastuzumab biosimilar products to include Kanjinti and Trazimera as of April 1, 2024 (previously Kanjinti and Ogivri). With this change, starting April 1, 2024, Ogivri will change to a non-preferred trastuzumab biosimilar product and will have prior authorization added, and Trazimera will have prior authorization removed. See list below.

White Blood Cell Growth Factors policy

We are updating our preferred pegfilgrastim biosimilar products to include Fulphila and Nyvepria as of April 1, 2024 (previously Udenyca and Ziextenzo). With this change, starting April 1, 2024, Udenyca/Udenyca Onbody and Ziextenzo will change to non-preferred pegfilgrastim biosimilar products and will have prior authorization added, and Fulphila and Nyvepria will have prior authorization removed. See list below.

Preferred Trastuzumab Containing Agent(s) (Unrestricted)

• Kanjinti™ (trastuzumab-anns)
• Trazimera™ (trastuzumab-qyyp)

Non-Preferred Trastuzumab Containing Agent(s)

• Herceptin® (trastuzumab)
• Herzuma® (trastuzumab-pkrb)
• Ontruzant™ (trastuzumab-dttb)
• Ogivri™ (trastuzumab-dkst)
• Herceptin Hylecta™ (trastuzumab and hyaluronidase-oysk)

Preferred Pegfilgrastim Products (Unrestricted)

• Fulphila® (pegfilgrastim-jmdb)
• Nyvepria™ (pegfilgrastim-apgf)

Non-Preferred Long-Acting/Pegfilgrastim Products

• Fylnetra® (pegfilgrastim-pbbk)
• Neulasta®, Neulasta® OnPro® (pegfilgrastim)
• Stimufend® (pegfilgrastim-fpgk)
• Rolvedon™ (eflapegrastim-xnst)
• Udenyca®, Udenyca Onbody (pegfilgrastim-cbqv)
• Ziextenzo® (pegfilgrastim-bmez)
• Ryzneuta® (efbemalenograstim alfa-vuxw)

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 a non-preferred biosimilar drug should be moved to our preferred products as soon as possible.

Providers requesting prior authorization for a non-preferred product on or after April 1, 2024, for an applicable Commercial member will need to submit the request through MHK (accessed via Blue e). No action is needed prior to April 1, 2024.