February 2025 Provider News - Bonus Edition
Date: 02/14/25
In this issue:
- Pharmacy - Apple Health Preferred Drug List (PDL)
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Pharmacy
Apple Health Preferred Drug List (PDL)
Effective April 1, 2025 Washington Apple Health (Medicaid) will make a significant change to the preferred products in the Cytokine and CAM Antagonist drug class. Brand name Humira products will no longer be preferred. Select adalimumab biosimilars (see included list for specific products), Enbrel, Enbrel Sureclick and Spevigo will be the preferred products in this class.
This change will apply to all agency-contracted managed care organizations (MCOs) and the fee-for-service (FFS) program per the Apple Health PDL. For questions about the Apple Health PDL, please email applehealthpharmacypolicy@hca.wa.gov.
| Preferred adalimumab biosimilars | ||||
|---|---|---|---|---|
| Product ID | Label Name | Generic Name | Strength | Dosage Form |
| 72606002206 | ADALIMUMAB-AATY(CF) | ADALIMUMAB-AATY | 40MG/0.4ML | SYRINGEKIT |
| 72606004101 | ADALIMUMAB-AATY(CF) | ADALIMUMAB-AATY | 20MG/0.2ML | SYRINGEKIT |
| 72606002210 | ADALIMUMAB-AATY(CF) AUTOINJ(2) | ADALIMUMAB-AATY | 40MG/0.4ML | AUTOINJKIT |
| 72606002209 | ADALIMUMAB-AATY(CF) AUTOINJECT | ADALIMUMAB-AATY | 40MG/0.4ML | AUTOINJKIT |
| 72606004004 | ADALIMUMAB-AATY(CF) AUTOINJECT | ADALIMUMAB-AATY | 80MG/0.8ML | AUTOINJKIT |
| 61314032764 | ADALIMUMAB-ADAZ(CF) | ADALIMUMAB-ADAZ | 40MG/0.4ML | SYRINGE |
| 61314032720 | ADALIMUMAB-ADAZ(CF) PEN | ADALIMUMAB-ADAZ | 40MG/0.4ML | PEN INJCTR |
| 00597055580 | ADALIMUMAB-ADBM(CF) | ADALIMUMAB-ADBM | 20MG/0.4ML | SYRINGEKIT |
| 00597056520 | ADALIMUMAB-ADBM(CF) | ADALIMUMAB-ADBM | 40MG/0.4ML | SYRINGEKIT |
| 00597058589 | ADALIMUMAB-ADBM(CF) | ADALIMUMAB-ADBM | 10MG/0.2ML | SYRINGEKIT |
| 00597059520 | ADALIMUMAB-ADBM(CF) | ADALIMUMAB-ADBM | 40MG/0.8ML | SYRINGEKIT |
| 00597057550 | ADALIMUMAB-ADBM(CF) PEN | ADALIMUMAB-ADBM | 40MG/0.4ML | PEN IJ KIT |
| 00597054566 | ADALIMUMAB-ADBM(CF) PEN CROHNS | ADALIMUMAB-ADBM | 40MG/0.8ML | PEN IJ KIT |
| 00597057560 | ADALIMUMAB-ADBM(CF) PEN CROHNS | ADALIMUMAB-ADBM | 40MG/0.4ML | PEN IJ KIT |
| 00597054544 | ADALIMUMAB-ADBM(CF) PEN PS-UV | ADALIMUMAB-ADBM | 40MG/0.8ML | PEN IJ KIT |
| 00597057540 | ADALIMUMAB-ADBM(CF) PEN PS-UV | ADALIMUMAB-ADBM | 40MG/0.4ML | PEN IJ KIT |
| 00597054522 | ADALIMUMAB-ADBM(CF)PEN | ADALIMUMAB-ADBM | 40MG/0.8ML | PEN IJ KIT |
| 00597037082 | CYLTEZO(CF) | ADALIMUMAB-ADBM | 40MG/0.8ML | SYRINGEKIT |
| 00597040089 | CYLTEZO(CF) | ADALIMUMAB-ADBM | 10MG/0.2ML | SYRINGEKIT |
| 00597040580 | CYLTEZO(CF) | ADALIMUMAB-ADBM | 20MG/0.4ML | SYRINGEKIT |
| 00597048520 | CYLTEZO(CF) | ADALIMUMAB-ADBM | 40MG/0.4ML | SYRINGEKIT |
| 00597037597 | CYLTEZO(CF) PEN | ADALIMUMAB-ADBM | 40MG/0.8ML | PEN IJ KIT |
| 00597049550 | CYLTEZO(CF) PEN | ADALIMUMAB-ADBM | 40MG/0.4ML | PEN IJ KIT |
| 00597037516 | CYLTEZO(CF) PEN CROHN'S-UC-HS | ADALIMUMAB-ADBM | 40MG/0.8ML | PEN IJ KIT |
| 00597049560 | CYLTEZO(CF) PEN CROHN'S-UC-HS | ADALIMUMAB-ADBM | 40MG/0.4ML | PEN IJ KIT |
| 00597037523 | CYLTEZO(CF) PEN PSORIASIS-UV | ADALIMUMAB-ADBM | 40MG/0.8ML | PEN IJ KIT |
| 00597049540 | CYLTEZO(CF) PEN PSORIASIS-UV | ADALIMUMAB-ADBM | 40MG/0.4ML | PEN IJ KIT |