Blue Cross and Blue Shield of Kansas City (Blue KC) is committed to providing affordable and accessible healthcare for our members, which is why we are making lower cost and FDA-approved biosimilar medications available to members starting January 1, 2025.<\/p>\n\n\n\n
To support this initiative of value improvement, we will be removing Humira from our formulary effective January 1, 2025, and adding three low-cost Humira biosimilar options. This change will offer our members comparable therapy at a significantly reduced cost. <\/p>\n\n\n\n
Effective January 1, 2025, a member may receive an exception to use Humira instead of a biosimilar option on our formulary, however the member will be responsible for the majority of the medication cost. We are making efforts to ensure this additional cost share is a last resort.<\/p>\n\n\n\n
As part of making biosimilars available to members, we are educating our brokers, prescribers, pharmacies, and individual members about this change. It is also important to share that we have selected biosimilar options that can be automatically substituted at the pharmacy.\u00a0\u00a0<\/p>\n\n\n\n
Member plan documents will be updated to encourage the use of cost-saving biosimilar options. The plan documents will state that a non-preferred* reference biologic medication will not be covered in full under the plan if a preferred* biosimilar medication is available.<\/p>\n\n\n\n
We recognize the costs of specialty medications have been a strain on healthcare affordability. We appreciate your support in helping us deliver on our mission to improve our members\u2019 health and the affordability of the healthcare they receive.<\/p>\n\n\n\n
Medication moving to excluded status<\/strong> Penalty for using a non-preferred reference biologic medication<\/strong> The penalty will be implemented January 1, 2025, for any non-preferred reference biologic medication with a preferred biosimilar. Our pharmacy team will work closely with all stakeholders to ensure a smooth transition and mitigate any disruption to therapy.<\/p>\n\n\n\n Who the penalty applies to<\/strong> Communications to members<\/strong>
As of January 1, 2025, Humira will move from preferred to excluded** status.<\/p>\n\n\n\n
If a member uses a non-preferred reference biologic medication*** when a preferred biosimilar medication is available, the non-preferred member cost share indicated in the benefit schedule and the reference biologic product penalty will apply.<\/p>\n\n\n\n\n
The penalty generally applies to all members, with the following exceptions:<\/p>\n\n\n\n\n
These audiences will receive notifications about the availability and coverage of biosimilars:<\/p>\n\n\n\n\n
Learn more about biological products<\/strong><\/h2>\n\n\n\n