MedicaidCoverageHigh impact
Reminder: preferred biosimilars to Humira and Stelara
Harvard Pilgrim Health Care·MA · Rheumatology, Gastroenterology, Dermatology·Provider Newsletter
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
MassHealth is transitioning from Humira and Stelara to preferred biosimilars effective January 5, 2026, with a grace period through March 31, 2026. After April 1, 2026, Humira and Stelara will require step therapy (trying preferred biosimilars first) and new prior authorizations for patients who haven't switched.
Action Required
By March 31, 2026: Billing team must identify all patients on Humira and Stelara and coordinate with providers to transition them to preferred biosimilars (Hadlima, adalimumab-adaz for Humira; Pyzchiva, Imuldosa, or Steqeyma for Stelara). Update prior authorization workflows in billing system for April 1, 2026 to require step therapy documentation for Humira/Stelara requests. Note that Imuldosa requires new prescriptions while others can be pharmacy-substituted.