Update to the Biosimilar Preferred Drug List-Correction

Dec 11, 2023

On December 1, 2023, the Office of MaineCare Services (OMS) notified providers of the changes to the Biosimilar Preferred Drug List effective January 4, 2024. The notice sent on December 1, 2023, inadvertently omitted the drug class Rituximab. Please be advised there were no changes to this drug class for 2024. 

Effective January 4, 2024, the Department will add preferred and non-preferred drugs to the Biosimilar Preferred Drug List (PDL).  

The Department will add the following preferred drugs:  

• Q5122 – Nyvepria, pegfilgrastim-apgf  

The Department will add the following non-preferred drugs:  

• Q5108 – Fulphila, pegfilgrastim-jmdb 
• Q5107 – Mvasi, bevacizumab-awwb  

The Biosimilar PDL, implemented in 2022, establishes preferred and non-preferred Physician-Administered Drugs (PADs). Preferred drugs are available without a Prior Authorization (PA). Providers must have members 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 January 4, 2024

 

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