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Pharmacy Blast: Transitioning to Biosimilar Drugs
What do I need to know?
Highmark is changing how certain prescription drugs are covered.
Beginning January 1, 2026, Commercial and Healthcare Reform formularies will no longer cover Humira and Stelara as preferred prescription drugs. Instead, we will be covering biosimilar drugs, which are very similar to the original brand name drugs in terms of safety and effectiveness. (This change will also include Stelara when administered through a medical benefit.)
- The preferred biosimilar drug for Humira is Simlandi.
- The preferred biosimilar drug for Stelara is Yesintek.
The Food and Drug Administration (FDA) requires strict testing to ensure biosimilar drugs work just as well as the original brand name drugs. The biosimilar drugs Highmark will be preferring are interchangeable, meaning pharmacies can usually provide the biosimilar drug without needing a new prescription from the prescribing physician.
Client Impact
This change will result in a significant reduction in category rebate value. However, this reduction should be offset by savings realized from the lower, more transparent biosimilar drug list price, ultimately leading to sustainable cost savings for both members and clients. This change will affect the rebate value earned for our ASO customers. Client-specific impact details are available from your Client Manager upon request at the time of the client’s renewal.
Member Impact
Any new or existing, prior authorization for Humira and/or Stelara that extends into 2026 will end on December 31, 2025. For members who are currently using Humira or Stelara, Highmark has already added a new authorization for the covered biosimilar drug that will remain in place for one year from the start date of the member’s most recent Humira or Stelara authorization approval.
Members will be informed of this change in early October. Copies of the member communications are included for your reference.
- Members who are impacted by the change based on the pharmacy benefit: Click here for a copy of the letter.
- Members who are impacted by the change based on coverage through their medical benefit: Click here for a copy of the letter.
- Members who are impacted by the change based on coverage through their medical benefit and who have channel alignment, meaning some self-administered products are covered under the pharmacy benefit rather than the medical benefit: Click here for a copy of the letter.
Members may have access to financial assistance through the specialty pharmacy or from the biosimilar drug manufacturers. To learn more about financial assistance available through the manufacturers, members can use the following contact information:
What do I need to do?
Inform your clients about this important update and resources that are available to their employees.
Where do I go with questions?
Please contact your Sales Executive or Client Manager with any additional questions.
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