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Harvard Pilgrim Health CareMedicaid · Coverage · Provider Newsletter · MA · Rheumatology, Gastroenterology, DermatologyHigh impact

Reminder: preferred biosimilars to Humira and Stelara

Act
by Mar 31, 2026
Effective date
Jan 5, 2026
Identified
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.

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What to do

by Mar 31, 2026 · 3 steps
01Billing 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).
02Update prior authorization workflows in billing system for April 1, 2026 to require step therapy documentation for Humira/Stelara requests.
03Note that Imuldosa requires new prescriptions while others can be pharmacy-substituted.

Original notice

Reminder: preferred biosimilars to Humira and Stelara
point32health.org · Always check the source before changing claims.
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Related changes

See all Harvard Pilgrim Health Care changes →
Reminder: preferred biosimilars to Humira and StelaraHighEffective Jan 5, 2026 · Provider NewsletterBrowse every Harvard Pilgrim Health Care change in the policy list

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Harvard Pilgrim Health Care policiesMA policy changesRheumatologyGastroenterologyDermatology

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