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New Policies for Biologics with Biosimilars

  • November 13, 2020
  • |Quartz
|
As you know, information is always subject to change.
There may have been updates since this blog post was published.
Questions? Please contact Customer Service
doctor
Effective January 1, 2021, Quartz will no longer cover brand biologics when a biosimilar is available unless the brand is being used for intravitreal injections. At this time, Quartz does not have a preference as to which biosimilar is used.
 
Biosimilars of the following products will be covered without prior authorization:
  • Avastin
  • Epogen
  • Herceptin
  • Neupogen
  • Procrit
  • Rituxan
Biosimilars of the following products will require an approved prior authorization for coverage:
  • Neulasta
  • Remicade
 
After January 1, 2021, claims for the brand biologic will be denied unless there is an approved prior authorization or the brand is being used for intravitreal injections. If your patient has already been switched to the biosimilar, thank you. If they have not, they will have coverage of the brand biologic through December 31, 2020, and will need to be changed to the biosimilar for any doses after January 1, 2021.
  • If your patient is a Quartz Medicare Advantage member currently receiving one of the above medications and they have not switched to the biosimilar, they will have coverage of the brand until at least December 31, 2021. After that time, if our criteria have an approval limit, your patient would require a renewed prior authorization approval for Quartz to continue covering the medication.

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New Policies for Biologics with Biosimilars

  • November 13, 2020
  • |Quartz
|
As you know, information is always subject to change.
There may have been updates since this blog post was published.
Questions? Please contact Customer Service
doctor
Effective January 1, 2021, Quartz will no longer cover brand biologics when a biosimilar is available unless the brand is being used for intravitreal injections. At this time, Quartz does not have a preference as to which biosimilar is used.
 
Biosimilars of the following products will be covered without prior authorization:
  • Avastin
  • Epogen
  • Herceptin
  • Neupogen
  • Procrit
  • Rituxan
Biosimilars of the following products will require an approved prior authorization for coverage:
  • Neulasta
  • Remicade
 
After January 1, 2021, claims for the brand biologic will be denied unless there is an approved prior authorization or the brand is being used for intravitreal injections. If your patient has already been switched to the biosimilar, thank you. If they have not, they will have coverage of the brand biologic through December 31, 2020, and will need to be changed to the biosimilar for any doses after January 1, 2021.
  • If your patient is a Quartz Medicare Advantage member currently receiving one of the above medications and they have not switched to the biosimilar, they will have coverage of the brand until at least December 31, 2021. After that time, if our criteria have an approval limit, your patient would require a renewed prior authorization approval for Quartz to continue covering the medication.

Comments

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Thank you for the comment! Your comment must be approved first