← Back to list
Changes to Preferred Biosimilar Medications
Act
by Sep 15, 2026
Effective date
Oct 1, 2026
Identified
Aug 19, 2026
Summary
MO HealthNet is restructuring its preferred biosimilar medication list effective October 1, 2026, moving several biologic agents to non-preferred status while designating specific biosimilars as preferred for infliximab, adalimumab, and ustekinumab. Current clinical prior authorizations remain valid, but patients on non-preferred agents must switch to preferred alternatives unless an override is explicitly approved; no new clinical PA is required for the transition.
Get alerts when payers change rules like this one
We check Missouri Medicaid (MO HealthNet) and other payers every day and email you when a change matches your specialty and state.
Get Missouri Medicaid (MO HealthNet) alertsPolicy Monitoring is free. No card required.
What to do
by Sep 15, 2026 · 4 steps
01Billing and clinical teams must audit all active patient regimens to identify those currently receiving non-preferred biosimilar agents (Avsola, Idacio, Remicade, Renflexis, Zymfentra for infliximab; Abrilada, Adalimumab-aacf, Adalimumab-aaty, Adalimumab-adbm, Adalimumab-ryvk, Amjevita, Cyltezo, Hulio, Humira, Hyrimoz, Idacio, Simlandi, Yuflyma, Yusimry for adalimumab; Imuldosa, Otulfi, Selarsdi, Starjemza, Stelara, Steqeyma, Ustekinumab, Yesintek for ustekinumab).
02Before October 1, 2026: Notify prescribers and coordinate with patients and their pharmacies to transition non-preferred patients to the preferred biosimilar alternatives (Inflectra or Infliximab for infliximab; Adalimumab-adaz or Hadlima for adalimumab; Pyzchiva for ustekinumab).
03Update pharmacy benefit management system and billing software to enforce the new Biosimilar vs. Reference Product Fiscal Edit effective October 1, 2026.
04Document that existing clinical PAs remain valid during transition but mandatory product switching will be enforced unless override approval is obtained.
If missed: Failure to transition patients to preferred agents may result in claim denials or coverage gaps after October 1, 2026.
Original notice
Changes to Preferred Biosimilar Medications
mydss.mo.gov · Always check the source before changing claims.