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Providers
November 2024
In This Issue
► November news: Executive summary
► Fee schedules now available via Availity Essentials portal
► Prefix replacements for 2025
► 2025 Provider Operating Guide preview starts December 2
► More biosimilars get preferred status for 2025
► Quarterly fee schedule updates effective January 1
More biosimilars to get “preferred” status for 2025
Good news! We have expanded our use of biosimilars to help reduce prescription drug costs for AZ Blue members. Effective January 1, 2025, more biosimilars will be on the list of preferred medications.
To ensure coverage, start with the preferred products
When you prescribe listed drugs, please start with the preferred options. We will only cover a non-preferred option after the preferred products have been tried and failed, or are contraindicated.
The right biosimilars can help lower member cost
The use of preferred biosimilars may lower drug cost share for members by an average of 15%-20%. But are they safe and effective? Yes. The FDA evaluates and approves biosimilar drugs only after research determines that:
1. The biosimilar has been proven to be almost identical to the original reference biologic.
2. There are no substantive clinical differences in terms of safety and efficacy.
3. There are only minor differences in the inactive components.1
Effective No clinical difference when compared with the reference biologic Identical in dosage form and administration route
Safe Same use indications
Manufactured under the same FDA standards
Positive Patient Experience Same patient health outcomes
Average cost of a preferred biosimilar may be 15%-20% less than a non-preferred product
Preferred status list
This updated list highlights the 2025 preferred status changes in yellow:
Medication Product Code Preferred Status
Bevacizumab Avastin® (brand reference) J9035 Preferred
Mvasi® (biosimilar) Q5107 Preferred
Alymsys® (biosimilar) Q5126 Non-preferred
Vegzelma® (biosimilar) J3590 Non-preferred
Zirabev® (biosimilar) Q5118 Non-Preferred
Filgrastim Nivestym® (biosimilar) Q5110 Preferred
Zarxio® (biosimilar) Q5101 Preferred
Granix® (biosimilar) J1447 Non-preferred
Neupogen® (brand reference) J1442 Non-preferred
Releuko® (biosimilar) Q5125 Non-preferred
Infliximab Inflectra® (biosimilar) Q5103 Preferred
Renflexis® (biosimilar) Q5104 Preferred
Avsola® (biosimilar) Q5121 Non-preferred
Infliximab (biosimilar) J1745 Non-preferred
Remicade® (brand reference) J1745 Non-preferred
Pegfilgrastim Fulphila® (biosimilar) Q5108 Preferred
Fylnetra® (biosimilar) J3590 Preferred
Neulasta®/Neulasta® Onpro® (brand reference) J2506 Preferred
NyvepriaTM (biosimilar) Q5122 Non-preferred
Stimufend® (biosimilar) J3590 Non-preferred
Udenyca® (biosimilar) Q511 Non-preferred
Ziextenzo® (biosimilar) Q5120 Non-preferred
Ranibizumab ByoovizTM (biosimilar) Q5124 Preferred
Lucentis® (biosimilar) J2778 Preferred
Cimerli® (biosimilar) Q5128 Non-preferred
Rituximab Rituxan® (brand reference) J9312 Preferred
Ruxience® (biosimilar Q5119 Preferred
RiabniTM (biosimilar) Q5123 Non-preferred
Truxima® (biosimilar) Q5115 Non-preferred
Trastuzumab Kanjinti® (biosimilar) Q5117 Preferred
Ogivri® (biosimilar) Q5114 Preferred
TrazimeraTM (biosimilar) Q5116 Preferred
Herceptin® (brand reference) J9355 Non-preferred
Herzuma® (biosimilar) Q5113 Non-preferred
Ontruzant® (biosimilar) Q5112 Non-preferred
Brand reference = the biologic that was first to market and is used for biosimilar comparison.
REMINDER: We require trial and failure, or contraindication of all preferred products before we will cover the use of a non-preferred option.
Let your prescribers know about the changes
Please share this information with your clinical and administrative support teams. You can find our Medical Drug and Biosimilar Step Therapy guidelines at azblue.com/pharmacy. Go to one of the resource pages and look under "Pharmacy Coverage Guidelines > PCGs (for drugs and devices that may be covered under medical benefits) > Biosimilar Step Therapy."
If you have questions about the updates, feel free to contact the AZ Blue Pharmacy team at 602-864-4028 or send an email to PharmCare@azblue.com.
1 Source: FDA, “Biosimilar and Interchangeable Biologics: More Treatment Choices”
In This Issue
► November news: Executive summary
► Fee schedules now available via Availity Essentials portal
► Prefix replacements for 2025
► 2025 Provider Operating Guide preview starts December 2
► More biosimilars get preferred status for 2025
► Quarterly fee schedule updates effective January 1
Zirabev, Nivestym, Inflectra, Nyvepria, Ruxience, and Trazimera are registered trademarks of Pfizer Inc.
Avastin, Herceptin, and Lucentis are registered trademarks of Genentech USA, Inc.
Alymsys, Releuko, and Fylnetra are registered trademarks of Amneal Pharmaceuticals LLC.
Mvasi, Neupogen, Avsola, Neulasta, Onpro, and Riabni are registered trademarks of Amgen, Inc.
Kanjinti is a trademark owned or licensed by Amgen, Inc., its subsidiaries, or affiliates.
Vegzelma is a registered trademark of Celltrion Healthcare Co., Ltd.
Truxima and Herzuma are registered trademarks of Celltrion Inc., used under license.
Granix is a registered trademark of Teva Pharmaceutical Industries Ltd.
Zarxio and Ziextenzo are registered trademarks of Sandoz AG.
Renflexis and Ontruzant are registered trademarks of Organon.
Remicade is a registered trademark of Johnson & Johnson Innovative Medicine.
Fulphila and Ogivri are registered trademarks of Biosimilars Newco Ltd., a Biocon Biologics Co.
Stimufend is a registered trademark of Fresenius Kabi.
Udenyca and Cimerli are registered trademarks of Coherus BioSciences, Inc.
Rituxan and Byooviz are registered trademarks of Biogen, Inc.

Blue Cross, Blue Shield, the Cross and Shield Symbols, are registered service marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

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