UnitedHealthcare Will Prefer Brand-Name Pegfilgrastim Starting in July 2019

This article has been updated.

In its May 2019 network bulletin, UnitedHealthcare announced that, as of July 1, it will prefer the use of brand-name pegfilgrastim, Amgen’s Neulasta, over biosimilar options.

According to the bulletin, use of Neulasta Onpro (a presentation of the pegfilgrastim product in an on-body injector device) or Neulasta in a vial will be required before use of Mylan and Biocon’s biosimilar, Fulphila, or Coherus BioSciences’ biosimilar, Udenyca.

Additionally, UnitedHealthcare’s commercial plans will expand current prior authorization requirements to include the use of pegfilgrastim for any diagnosis. For current commercial plan members, existing authorizations will be honored through their end date, but providers are encouraged to begin prescribing the preferred Neulasta.

Also, as of August 1, brand-name filgrastim, Amgen’s Neupogen, will require prior authorization, as will its biosimilars: Pfizer’s Nivestym, Sandoz’s Zarxio, and Teva’s Granix (a follow-on product approved before the biosimilar pathway was established in the United States).

UnitedHealthcare also now prefers other reference products to biosimilars; brand-name infliximab, Remicade, is the preferred infliximab product. These changes represent a shift from UnitedHealthcare’s previous approach, under which Celltrion’s biosimilar, Inflectra, and Samsung Bioepis’ and Merck’s biosimilar, Renflexis, were preferred products and brand-name Remicade was not. A representative from UnitedHealthcare has told The Center for Biosimilars^® in an email that, in October 2019, a change will take effect adding Inflectra to a preferred position along with Remicade. As such, beginning October 1, both Remicade and Inflectra will be preferred options for UnitedHealthcare commercial members.

Access to Inflectra and Renflexis now requires that a patient have tried and failed (or have had intolerance to) the reference drug. Physicians must attest that clinical response to a biosimilar would be expected to be superior to that of Remicade, or that a patient who did not tolerate Remicade would be expected to tolerate the biosimilar.

Notably, the practice of switching to a biosimilar in the case of treatment failure or intolerance to a reference drug is a practice that contradicts the European League Against Rheumatism’s recommendations, which indicate that switching to a different drug altogether would be appropriate in such a scenario, given the fact that biosimilars are not expected to have any clinically meaningful differences from their reference products.