Fylnetra, Stimufend, and Rolvedon Medical Step Therapy Notice

This is a correction to an article that was posted on August 1, 2023. The effective date was listed as July 1, 2023, in error. The correct effective date is October 1, 2023. 

Effective for dates of service on and after October 1, 2023, the following specialty pharmacy codes from current or new Clinical Criteria documents will be included in our existing specialty pharmacy medical step therapy review process. Step therapy review will apply upon prior authorization initiation or renewal, in addition to the current medical necessity review of all drugs noted below.

Clinical Criteria CC-0002 currently has a step therapy preferring Neulasta, Neulasta OnPro, and the biosimilar Udenyca. This update is to provide notification that the new biosimilars Fylnetra and Stimufend and the new long-acting colony stimulating factor Rolvedon will be added to existing step therapy as non-preferred agents.

The list of Clinical Criteria is publicly available on our provider website. Visit the Clinical Criteria website to search for specific Clinical Criteria.