Effective January 1, 2021, the CalPERS PERS Select, PERS Choice and PERSCare PPO basic plans have been redesigned to require the utilization of the biosimilar agent infliximab-axxq (Avsola), infliximab-abda (Renflexis) or infliximab-dyyb (Inflectra) instead of Remicade. 

What is a Biosimilar?

Biosimilar pharmaceuticals are highly similar drugs that meet the FDA’s rigorous standards for approval, are manufactured in FDA-licensed facilities, and are tracked as part of post-market surveillance to ensure continued safety. The changes listed in the table below apply to all CalPERS basic PPO adult members, effective January 1, 2021.


Effective for all basic PERSCare, PERS Choice and PERS Select PPO Basic members on July 1, 2020

Therapeutic Class

Medication

Benefit Change

Injectable Medication

infliximab (Remicade)

Members age 18 years and older who have not received infliximab (Remicade) therapies in the last 12 months must be directed to the biosimilars Avsola, Renflexis or Inflectra


What action do I need to take?

CalPERS PERS Select, PERS Choice and PERSCare PPO basic members needing this specific therapy must be directed to the approved therapy of Avsola, Renflexis or Inflectra. To ensure care is delivered timely, please initiate all prior authorization requests for CalPERS PPO members for Avsola, Renflexis or Inflectra.

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November 2020 Anthem Blue Cross Provider News - California