Humira (adalimumab) and Biosimilars prior authorization
Defines prior authorization, step therapy, quantity/ specialty dispensing and medical necessity criteria for Humira (adalimumab) and listed biosimilars for Mass General Brigham Health Plan members across pharmacy and medical benefits.
Updated criteria for Crohn's disease and ulcerative colitis to remove disease-characteristic requirement and allow approval if disease severity warrants systemic biologic as first-line therapy.
Added multiple specific adalimumab non-preferred biosimilar products and clarified that non-preferred agents require prior use of two preferred agents in many indications.
Clarified step therapy language to indicate member must be new to the plan within past 90 days for certain authorizations.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.