MedicaidPrior AuthMedium impact
Physician Administered Drug Biosimilar PDL
South Dakota Medicaid·SD · Rheumatology, Oncology, Gastroenterology +1 more·Pharmacy
Effective date
May 15, 2026
We identified it
Jun 21, 2026
Summary
South Dakota Medicaid is implementing a new Preferred Drug List (PDL) for physician-administered biosimilar drugs, requiring prior authorization for non-preferred agents with a 90-day trial of preferred drugs first. The policy rolls out in phases: tocilizumab (May 15, 2026), infliximab (June 15, 2026), and pegfilgrastim (July 15, 2026).
Action Required
By May 15, 2026: Update billing system to flag non-preferred tocilizumab products (AVTOZMA, ACTEMRA, TOFIDENCE) for prior authorization requirements. By June 15, 2026: Add prior auth flags for non-preferred infliximab products (AVSOLA, INFLECTRA, REMICADE, RENFLEXIS). By July 15, 2026: Add prior auth flags for non-preferred pegfilgrastim products (NEULASTA, UDENYCA, ZIEXTNEZO, FYLNETRA, NYVEPRIA, STIMUFEND). Train staff that preferred agents require no prior authorization, while non-preferred agents need 90-day trial documentation of preferred drugs. Claims for non-preferred agents without proper prior authorization will be denied.