Effective April 1, 2022, AmeriHealth will designate the following oncology and oncology adjunct therapies as preferred products:
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Bevacizumab (marketed as Avastin®)* | - Mvasi™ (bevacizumab-awwb)
- Zirabev® (bevacizumab-bvzr)
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Pegfilgrastim (marketed as Neulasta®) | - Fulphila® (pegfilgrastim-jmdb)
- Neulasta® (pegfilgrastim)
- Ziextenzo® (pegfilgrastim-bmez)
NEW!
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Rituximab (marketed as Rituxan®)** | - Riabni™ (rituximab-arrx)
NEW!
- Ruxience™ (rituximab-pvvr)
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Trastuzumab (marketed as Herceptin®) | - Kanjinti™ (trastuzumab-anns)
- Trazimera™ (trastuzumab-qyyp)
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*Bevacizumab will continue to be covered for ophthalmologic indications, without precertification approval, for all branded products (e.g., Avastin, Mvasi, Zirabev).
**Rituximab preferred products apply to all oncology and non-oncology indications.
What are the changes?
There will be new preferred products for pegfilgrastim and rituximab,
effective April 1, 2022. AmeriHealth began designating preferred products for these drugs in July 2020 and April 2021. The preferred products for bevacizumab and trastuzumab have not changed since our initial launch.
Why are these changes happening?
AmeriHealth is constantly evaluating best practice standards and industry trends to help manage specialty drug costs. Bevacizumab, pegfilgrastim, rituximab, and trastuzumab are highly used biologics. The FDA has approved several biosimilars for these products. According to the FDA, biosimilars have no clinically meaningful difference from FDA-approved reference products in terms of safety and effectiveness.1
Updating our preferred products allows AmeriHealth to take advantage of the growing availability of biosimilars, as well as the competition between biosimilars and reference products. This competition may reduce costs and expand members' access to more affordable therapies.
How will this affect my patients?
To preserve continuity of care, AmeriHealth will continue to cover nonpreferred products for those members who currently have precertification approval for the drugs. These members will not be required to transition to a preferred product. However, if the provider and member want to switch to a preferred product, they may do so.
New coverage requests for bevacizumab, pegfilgrastim, rituximab, and trastuzumab will only be approved for the preferred product, in accordance with our medical policies.
Policy updates
AmeriHealth medical policies for pegfilgrastim and rituximab were updated to reflect the new coverage criteria for preferred products. Those policies will be posted as Notifications on December 31, 2021 and will go into effect April 1, 2022. Here is a complete list of medical policies for preferred oncology and oncology adjunct products:
- #08.00.33p: Trastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta™)
- #08.00.50z: Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)
- #08.00.66p: Bevacizumab (Avastin®) and Related Biosimilars for Oncologic Use
- #08.01.32h: Pegfilgrastim (Neulasta®) and Related Biosimilars
To view the Notifications for these policies, please visit our
Medical and Claim Payment Policy Portal.
Learn more
If you have any questions related to this information, please review our Preferred Oncology Products: Frequently Asked Questions (FAQ).
1U.S. Food & Drug Administration. “Biosimilar and Interchangeable Products." 2017. Available from:
https://www.fda.gov/drugs/biosimilars/biosimilar-and-interchangeable-products