Starting July 1, 2020, EmblemHealth has selected preferred products for all lines of business for bevacizumab, trastuzumab, and rituximab. This does not apply to EmblemHealth City of New York members.
Members who received authorization prior to July 1, 2020 may continue treatment with the Non-Preferred Drugs listed below. Non-Medicare members who start therapy on or after July 1, 2020 must have a trial and therapeutic failure of a Preferred Alternative Drug prior to approval of a Non-Preferred Drug.
Preferred products also require preauthorization.
| Chemical Name | Non-Preferred Drug(s) | Preferred Alternative Drug(s) |
|---|---|---|
| bevacizumab | Avastin (J9035)* | Mvasi (Q5107) Zirabev (Q5118) |
| trastuzumab | Herceptin (J9355) Herzuma (Q5113) Ontruzant (Q5112) |
Kanjinti (Q5117) Ogivri (Q5114) Trazimera (Q5116) |
| rituximab | Rituxan (J9312)= | Ruxience (J9999) Truxima (Q5115) |
*Oncology indications only