MedicaidPrior AuthHigh impact
Provider Letter 2024-28: RE: Prior Authoriza/on of Alymsys®, Avzivi® and Vegzelma® — effec/ve Jan. 13, 2025
Oklahoma SoonerCare·OK · Oncology·Provider Letter
Effective date
Jan 13, 2025
We identified it
Jun 20, 2026
Summary
Starting January 13, 2025, Oklahoma Medicaid (SoonerCare) will require prior authorization for three specific bevacizumab biosimilars: Alymsys, Avzivi, and Vegzelma. Three other bevacizumab products (Avastin, Mvasi, and Zirabev) will remain prior auth-free.
Action Required
By January 13, 2025: Billing team must implement prior authorization requirements for Alymsys, Avzivi, and Vegzelma for all SoonerCare members. Use drug-specific PA form PHARM-166 available on OHCA website. For patients who started therapy after December 1, 2024, submit PA requests immediately to avoid treatment disruption. Submit all PA requests to Pharmacy Prior Authorization Unit via fax (not Medical Authorization Unit or online portal). For SoonerSelect members, follow their specific health plan PA process instead.