Correction to the Biosimilar Preferred Drug List 

May 27, 2022

In a prior e-message, sent on May 16, 2022, the procedure code for trastuzumab, Herceptin, was incorrectly listed.  The correct procedure code is J9355 and is reflected in the updated table below. 

The Department is not enforcing the Biosimilar PDL requirement until 60-days after the effective date of the rule, July 13, 2022. The delay is to allow providers time to use non-preferred drugs that they have in stock. 

The following information provided in the prior e-message remains accurate: 

Through adoption of MaineCare Benefits Manual Chapter II, Section 90.04-7(B), Biosimilar Preferred Drug List, and pursuant to P.L. 2021, Ch. 398, Sec. A-17, An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2021, June 30, 2022 and June 30, 2023, the Department is implementing a Biosimilar Preferred Drug List (PDL). The Biosimilar PDL establishes preferred and non-preferred Physician-Administered Drugs (PADs). Preferred drugs are available without a Prior Authorization (PA).  Providers must try preferred drugs first.  

Non-preferred drugs require a Prior Authorization (PA). PA forms are available on the Health PAS Online Portal.   For the Department to consider approving  a non-preferred drug, the provider must include with their PA request documentation of preferred drug failure due to lack of efficacy, intolerable side effects to the preferred drug, or clinical exceptions.  Clinical exceptions include the presence of a condition that prevents usage of the preferred drug or a significant drug interaction between another drug and the preferred drug.