Update to the ​Biosimilar Preferred Drug List

Mar 10, 2023

Effective April 3, 2023, the Department will add preferred and non-preferred drugs to the Biosimilar Preferred Drug List (PDL).    

The Department will add the following preferred drugs:   

• C9257 – Avastin, bevacizumab  

• Q5119 – Ruxience, rituximab-pvvr     

The Department will add the following non-preferred drugs:   

• J9312 – Rituxan, rituximab   

• Q5123 – Riabni, rituximab-arrx   

• Q5115 – Truxima, rituximab-abbs    

The Biosimilar PDL, which the Department implemented in 2022, 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 PA form, which is 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.      

Biosimilar Preferred Drug List Effective April 3, 2023  

  

Infliximab and Biosimilars
Preferred Drugs	Non Preferred Drugs (PA required)
Q5121 - AVSOLA, infliximab-axxq	Q5103 - INFLECTRA, infliximab-dyyb
Q5104 - RENFLEXIS, infliximab-abda	J1745 - REMICADE, infliximab
Pegfilgrastim and Biosimilars
Preferred Drugs	Non Preferred Drugs (PA required)
Q5108 - FULPHILA, pegfilgrastim-jmdb	J2506 - NEULASTA, pegfilgrastim
Q5120 - ZIEXTENZO, pegfilgrastim-bmez	Q5122 - NYVEPRIA, pegfilgrastim-apgf
	Q5111 - UDENYCA, pegflgrastim-cbqv
Bevacizumab and Biosimilars
Preferred Drugs	Non Preferred Drugs (PA required)
Q5107 - MVASI, bevacizumab-awwb	J9035 - AVASTIN, bevacizumab
Q5118 - ZIRABEV, bevacizumab-bvzr
C9257 – AVASTIN, bevacizumab
Trastuzumab and Biosimilars
Preferred Drugs	Non Preferred Drugs (PA required)
Q5116 - TRAZIMERA, trastuzumab-qyyp	J9355 - HERCEPTIN, trastuzumab
	Q5113 - HERZUMA, trastuzumab-pkrb
	Q5117 - KANJINTI, trastuzumab-anns
	Q5114 - OGIVRI, trastuzumab-dkst
	Q5112 - ONTRUZANT, trastuzumab-dttb
Rituximab and Biosimilars
Preferred Drugs	Non Preferred Drug (PA required)
Q5119- Ruxience, rituximab-pvvr	J9312- Rituxan, rituximab
	Q5123- Riabni, rituximab-arrx
	Q5115- Truxima, rituximab-abbs

    

Please contact your Provider Relations Specialist with questions regarding PA form use.