UnitedHealthcare Patients Will Switch to Biosimilar Epoetin Alfa in 2020

UnitedHealthcare has revised its community and commercial plans’ coverage of erythropoiesis-stimulating agents. Effective January 1, 2020, patients who are receiving the reference epoetin alfa, Epogen or Procrit, will be required to switch to Pfizer’s biosimilar, Retacrit.

Patients who wish to remain on the reference epoetin alfa will need to meet medical necessity criteria; Epogen or Procrit are considered medically necessary if a patient had minimal clinical response to Retacrit and a physician attests that a superior response would be expected from Epogen or Procrit, or if the patient has a history of intolerance to, contraindication to, or failure of Retacrit that a physician attests would not be expected with Epogen or Procrit.

Additionally, coverage for Retacrit will not require prior authorization for patients who meet diagnosis-specific criteria for indications including anemia due to chronic kidney disease, anemia due to chemotherapy, and anemia associated with myelodysplastic disease, among others.

The new policy does not apply to community plans in Kansas or Louisiana.

This revision to UnitedHealthcare’s coverage comes after the payer made a prior notable move to prefer biosimilars of anticancer drugs. In August of this year, UnitedHealthcare indicated that, starting in October, it would prefer biosimilar bevacizumab (Mvasi) and biosimilar trastuzumab (Kanjinti), both made by Amgen, to the reference drugs, Avastin and Herceptin, respectively.

It also has made biosimilar filgrastim (Zarxio) a preferred product over follow-on filgrastim (Granix, or tbo-filgrastim), the reference filgrastim (Neupogen), and a competing biosimilar filgrastim (Nivestym).

Finally, a representative from UnitedHealthcare previously told The Center for Biosimilars^® in an email that it planned to add biosimilar infliximab (Inflectra) to a preferred position along with the brand-name infliximab (Remicade).