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Changes to Preferred Biosimilar Medications Effective October 1, 2026

Missouri Medicaid (MO HealthNet)·MO · Rheumatology, Gastroenterology, Dermatology +4 more·Provider Notice
Effective date
Oct 1, 2026
We identified it
Aug 4, 2026
Days to comply
58 days

Summary

MO HealthNet is changing preferred biosimilar medications effective October 1, 2026. Infliximab, Adalimumab, and Ustekinumab will have new preferred and non-preferred agent designations. Patients currently on non-preferred agents must switch to preferred versions unless an override is approved. Existing prior authorizations remain valid, but mandatory product switching will be enforced at the fiscal edit level.

Action Required

Before Oct 1, 2026
By September 15, 2026: Billing and clinical teams must identify all active MO HealthNet participants currently prescribed non-preferred biosimilars (Avsola, Idacio, Remicade, Renflexis, Zymfentra for Infliximab; Abrilada, Idacio, Yuflyma, Cyltezo, Simlandi, Amjevita, Cyltezo, Hulio, Humira, Hyrimoz, Idacio, Simlandi, Yuflyma, Yusimry for Adalimumab; Imuldosa, Otulfi, Selarsdi, Starjemza, Stelara, Steqeyma, Ustekinumab, Yesinteka for Ustekinumab). Coordinate with prescribers and pharmacy providers to transition patients to preferred agents before October 1, 2026. Update billing system edits to enforce mandatory product switching to preferred biosimilars on or after October 1. Existing clinical prior authorizations will remain valid without requiring new PA submissions, but claims will be rejected at the fiscal edit level if non-preferred agents are billed after the effective date unless an explicit override is obtained. Pharmacy team should proactively contact prescribers for patients on non-preferred agents to request override requests if clinically necessary. Document all override approvals in the system to prevent claim denials.

Affected Billing Codes

J1100
J1124
J1125
J1596
J1597
J1652
J1653
J1655
J1656
J1657
J1658
J1659
J1660
J1661
J1662
J1663
J1664
J1665
J1666
J1667
Q5103
Q5104
Q5105
Q5106
Q5107
Q5108
Q5109
Q5110
Q5111
Q5112
Q5113
Q5114
Q5115
J3358
J3359
J3360
J3361
J3362
J3363
Q5117
Q5118
Q5119
Q5120
Q5121