MedicaidCoverageHigh impact
Reminder: preferred biosimilars to Humira and Stelara
Harvard Pilgrim Health Care·MA · Dermatology, Rheumatology, Gastroenterology +1 more·Provider Newsletter
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
MassHealth is transitioning from brand-name Humira and Stelara to preferred biosimilars effective January 5, 2026. Brand-name drugs will remain covered through March 31, 2026, but starting April 1, 2026, they become non-preferred and require step therapy with prior authorization.
Action Required
By March 31, 2026: Billing team must identify all Tufts Health Together/MassHealth patients currently on Humira or Stelara. Coordinate with providers to transition patients to preferred biosimilars (Hadlima, adalimumab-adaz for Humira; Pyzchiva, Imuldosa, or Steqeyma for Stelara) before April 1, 2026. Update prior authorization workflows in billing system for brand-name drugs effective April 1. Note: Imuldosa requires new prescription while others can be pharmacy-substituted.