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Humira coverage is changing for Medicaid members

Here’s what you need to know:

Coverage of Humira (adalimumab) through PacificSource Community Solutions will change to other, biosimilar formulations.

Will I still be able to prescribe Humira?

Humira is the brand name of the active ingredient. Adalimumab is now available in other cost-effective formulations, so we will no longer provide Humira after September 15, 2023.

Will patients need a new prescription and prior authorization?

Yes, they’ll need a new prescription. Providers can send this authorization to your patients’ pharmacies. All formulations of adalimumab require prior authorization. PacificSource will honor existing authorizations for members switching directly from Humira.

Which adalimumab biosimilars will be covered?

• Adalimumab-adaz (Sandoz)

• Adalimumab-fkjp (Mylan)

• Hadlima (Organon)