At AmeriHealth we are constantly evaluating our policies and industry trends to identify innovative opportunities to make specialty drugs more affordable without limiting members’ access to life-saving medications. One of the ways in which we are doing this is by taking advantage of the growing availability of biosimilars in the United States and developing new strategies on how we use them. These strategies are based on many factors, including drug class, clinical efficacy, continuity of care, and value.

Effective May 15, 2020, the following biosimilars will be considered preferred products for all AmeriHealth members who are new starts to treatment:

^*Bevacizumab will continue to be covered for ophthalmologic indications, without precertification approval, for all branded products (e.g., Avastin, Mvasi, Zirabev).

Why is this change happening?

These three reference products are among the most commonly used specialty drugs. Biosimilars are approved by the U.S. Food & Drug Administration (FDA) as safe, effective treatment options. There are no clinically meaningful differences to branded biologics – like Avastin, Rituxan, and Herceptin – in terms of safety and effectiveness.

How will this affect my patients?

To preserve member continuity of care, AmeriHealth will continue to cover Avastin, Rituxan, and Herceptin for members who currently have precertification approval for those biologics. These members will not be required to transition to a preferred biosimilar.

New coverage requests for bevacizumab, rituximab, and trastuzumab will only be approved for the preferred biosimilars listed above, in accordance with our medical policies. According to the FDA, a biosimilar is a biological product that has no clinically meaningful difference from the existing FDA-approved reference product.¹ All biosimilar products meet the FDA’s rigorous standards for approval for the indications described in the product labeling. Once a biosimilar has been approved by the FDA, the safety and effectiveness of these products have been established, just as they have been for the reference product.

Policy updates

AmeriHealth medical policies will be updated to reflect new coverage criteria for these preferred biosimilars. The following policies were posted as Notifications on February 13, 2020, and will go into effect May 15, 2020:

• #08.00.33o: Trastuzumab (Herceptin^®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta^™)
• #08.00.50u: Rituximab (Rituxan^®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela^®)
• #08.00.66n: Bevacizumab (Avastin^®) and Related Biosimilars for Oncologic Uses

To view the Notifications for these policies, please visit our Medical Policy Portal. AmeriHealth will send targeted letters with more details to network providers affected by this change in March. 

Learn more

If you have any questions related to this information, please review our Oncology biosimilars: Frequently Asked Questions (FAQ). 

¹U.S. Food & Drug Administration. “Biosimilar and Interchangeable Products.” 2017. Available from: https://www.fda.gov/drugs/biosimilars/biosimilar-and-interchange able-products