Humira (adalimumab) biosimilar coverage
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Describes 2025 coverage guidance for Humira and preferred adalimumab biosimilars for Blue Advantage (HMO/PPO) members, including prior authorization and interchangeability notes that affect prescribers, pharmacists, and members.
No material clinical or coverage changes in this revision.
Provider Actions and Authorization Requirements
Prior authorization required for all new adalimumab prescriptions
All new adalimumab prescriptions require prior authorization before coverage; approved Humira authorizations apply to preferred adalimumab biosimilars and switching between preferred adalimumab products does not require a new authorization.
Approved Humira authorizations cover switching to preferred biosimilars
Members with an approved authorization for Humira do not require a new prior authorization to switch to any other preferred adalimumab product listed in this guide.
Required prior authorization documentation for new adalimumab starts
Providers must submit a prior authorization request for all new adalimumab prescriptions; existing approvals for Humira extend to preferred adalimumab biosimilars and do not require a new prior authorization when switching.
Coverage will be denied until prior authorization is approved
Failure to submit a prior authorization request for new adalimumab prescriptions will prevent coverage until an authorization is approved.
Initial Therapy Coverage Criteria
Initial Therapy Criteria
Covered when ALL of the following are met:
Approved prior authorizations for Humira apply to preferred adalimumab biosimilars; members with an approved Humira authorization do not require a new prior authorization to switch to any other preferred adalimumab product listed in this guide.
Humira and Biosimilar Coverage
Preferred Humira biosimilar (Yuflyma)
Yuflyma® (adalimumab) is listed as a preferred Humira biosimilar on the Blue Advantage formularies for 2025.
Definitions
Background
Adalimumab (Humira) is a tumor necrosis factor (TNF) inhibitor indicated for multiple inflammatory and autoimmune conditions, including rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, plaque psoriasis, hidradenitis suppurativa, and uveitis. These biologic therapies are large, complex molecules produced from living cells and are administered parenterally.
Biosimilars to adalimumab are biological products that are highly similar to the FDA‑approved reference product with no clinically meaningful differences in safety, efficacy, purity, or potency. They share the same route of administration, strength, dosage, treatment benefits, and potential side effects as the reference product and can provide lower‑cost alternatives to Humira.
Some biosimilars may be designated as interchangeable, meaning they meet additional regulatory requirements allowing pharmacy‑level substitution for the reference product. Note that Louisiana law requires patient consent and pharmacist notification to the prescriber within 5 business days after dispensing when an interchangeable biosimilar is substituted.
For 2025 Blue Advantage members, Humira and selected preferred adalimumab biosimilars are covered under the formulary; however, all new adalimumab prescriptions require prior authorization before coverage, and existing approvals for Humira apply to preferred biosimilars when switching among preferred products.
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