Effective January 1, 2022, the CalPERS PERS Platinum and PERS Gold PPO Basic Plans were redesigned to utilize biosimilar agents including but not limited to the following:

 

  • Mvasi, Zirabev instead of Avastin (bevacizumab)
  • Retacrit instead of Epogen and Procrit (epoetin alfa)
  • Nivestym, Zarxio instead of Neupogen (filgrastim)
  • Fulphila, Nyvepria, Udenyca, Ziextenzo instead of Neulasta (pegfilgrastim)
  • Riabni, Ruxience, Truxima, instead of Rituxan (rituximab)
  • Herzuma, Kanjinti, Ogivri, Ontruzant, and Trazimera and instead of Herceptin (trastuzumab)

 

Members aged 18 years and older who have not received the above drugs in the last 12 months, must be redirected to the biosimilar.  CalPERS has final authority over benefit changes for their PPO Plans and has elected to make a change in their benefit plan.

What is a Biosimilar?

 

  • A biosimilar is a biological product
    • FDA‐approved biosimilars have been compared to an FDA‐approved biologic, known as the reference product.
  • A biosimilar is highly similiar to a reference product
    • For approval, the structure and function of an approved biosimilar were compared to a reference product.
  • A biosimilar has no clinically meaningful differences in safety, purity, or potency compared to the reference product
  • A biosimilar is approved by the FDA after rigorous evaluation and testing by the
    • Because biosimilars meet the FDA’s standards for approval, are manufactured in FDA‐licensed facilities, and are tracked as part of post‐market surveillance to ensure continued safety; Prescribers and patients should have no concerns about using these medications instead of reference


Effective January 1, 2022, the changes listed in the table below will apply to CalPERS PERS Platinum and PERS Gold basic PPO adult members.

Effective for basic PERS Platinum and PERS Gold PPO members on January 1, 2022

Therapeutic Class

Medication

Benefit Change

Antineoplastic and Selective Vascular Endothelial Growth Factor (VEGF) Antagonist Agents

Bevacizumab (Avastin)

Members aged 18 years and older who have not received bevacizumab (Avastin) therapies in the last 12 months must be directed to the biosimilars Mvasi, Zirabev

Erythropoiesis Stimulating Agents

Epoetin alfa (Epogen and Procrit)

Members aged 18 years and older who have not received epoetin alfa (Epogen and Procrit) therapies in the last 12 months must be directed to the biosimilars Retacrit

Colony Stimulating Factor Agents

Filgrastim (Neupogen)

Members aged 18 years and older who have not received filgrastim (Neupogen) therapies in the last 12 months must be directed to the biosimilars Nivestym, Zarxio

Colony Stimulating Factor Agents

Pegfilgrastim (Neulasta)

Members aged 18 years and older who have not received pegfilgrastim (Neulasta) therapies in the last 12 months must be directed to the biosimilars Fulphila, Nyvepria, Udenyca, Ziextenzo

Antineoplastic and Monoclonal Antibody Agents

 

Rituximab (Rituxan)

Members aged 18 years and older who have not received rituximab (Rituxan) therapies in the last 12 months must be directed to the biosimilars Riabni, Ruxience, Truxima

 

Antineoplastic Agent

Trastuzumab (Herceptin)

Members aged 18 years and older who have not received trastuzumab (Herceptin) therapies in the last 12 months must be directed to the biosimilars Herzuma, Kanjinti, Ogivri, Ontruzant, Trazimera


What action do I need to take?

Direct eligible CalPERS PERS Platinum and PERS Gold PPO basic members needing this specific therapy to approved biosimilar agents including but not limited to the following:

  • Mvasi, Zirabev
  • Retacrit
  • Nivestym, Zarxio
  • Fulphila, Nyvepria, Udenyca, Ziextenzo
  • Riabni, Ruxience, Truxima
  • Herzuma, Kanjinti, Ogivri, Ontruzant, and Trazimera

 

To ensure care is delivered timely, please initiate all prior authorization requests, as appropriate, for CalPERS PERS Platinum and PERS Gold PPO basic members for the approved biosimilar therapy as described above.

What if I need assistance?

 

Call our dedicated Anthem Blue Cross CalPERS Customer Service Department at 1‐877‐737‐7776 if your patient cannot use an approved biosimilar therapy as described above. We recognize the unique aspects of patients’ cases.


1469-1221-PN-CA



Featured In:
December 2021 Anthem Blue Cross Provider News - California