CORRECTION: Changes to utilization requirements for Avsola, Renflexis and Inflectra for CalPERS PPO members only!

In the November 2020 edition of our provider newsletter, Anthem Blue Cross (Anthem) announced an important update to the CalPERS PERS Select, PERS Choice and PERSCare PPO basic plans, effective January 1, 2021. These 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. However, the date in the table published in the November 2020 edition of the Provider News was July 1, 2020. The correct date is January 1, 2021, as displayed in the table below.

 

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 January 1, 2021
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.

728-1120-PN-CA