CommercialCoverageHigh impact
Updates for Humira, Simlandi, and Stelara
Harvard Pilgrim Health Care·MA · Rheumatology, Gastroenterology, Dermatology +2 more·Provider Newsletter
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Point32Health (Harvard Pilgrim, Tufts Health Plan) is changing coverage for Humira, Stelara, and their biosimilars with different timelines by plan type. Commercial plans will prefer Simlandi over Humira starting March 2026, while Medicaid plans will prefer specific biosimilars starting January 2026 with step therapy requirements beginning April 2026.
Action Required
By January 5, 2026: Billing team must identify all patients on Humira and Stelara covered by Tufts Health Together (Medicaid) and coordinate with providers to transition to preferred biosimilars (Hadlima, adalimumab-adaz for Humira; Pyzchiva, Imuldosa, Steqeyma for Stelara) before March 31, 2026 coverage ends. By March 1, 2026: For commercial patients, write new prescriptions for Simlandi to replace Humira without needing new prior auth. Update prior authorization tracking system to note step therapy requirements for Humira/Stelara beginning April 1, 2026. Failure to transition patients will result in coverage denials and required step therapy documentation.