Clarification of Biosimilar Ocular Use 

Sep 30, 2022

MaineCare implemented a Biosimilar Preferred Drug List (PDL) this past May that establishes preferred and non-preferred Physician-Administered Drugs (PADs). Preferred drugs are available without a Prior Authorization (PA), and non-preferred drugs require a PA.  

Avastin is a non-preferred drug on the Biosimilar PDL that requires a PA. After clinical review, the Department determined that Avastin biosimilars should not be used for injection into the eye. Providers intending to use Avastin for this purpose must still submit a PA, but use of Avastin in the eye will constitute appropriate medical necessity for approval. The PA form, Physician-Administered Miscellaneous OR Non-Rebateable J-Codes, is available on the Health PAS Online Portal and must be accompanied by a valid National Drug Code (NDC) number and the provider’s signature.  

For all other uses of this non-preferred drug, the provider must submit a PA with documentation of preferred drug failure due to lack of efficacy, intolerable side effects to the preferred drug, or clinical exceptions.    

Please contact your Provider Relations Specialist, Tia Bolduc, with questions.