Biosimilar preferred program Form

Biosimilars are safe and effective treatment options available at a lower cost than brand-name expensive biologics. Low-cost, high-value biosimilars are preferred on the BSWHP Group Value and Group Choice formularies. The reference product or brand biologic is excluded as there is no significant clinical benefit. Preferred biosimilar products are typically available at a low member out-of-pocket cost—as low as $0/Rx. Preferred biosimilars Biologic Preferred biosimilars Effective date adalimumab (Humira) • Simlandi (adalimumab-ryvk) • Hadlima (adalimumab-bwwd) • Adalimumab-aaty (unbranded Yuflyma) 01/01/2025 ustekinumab (Stelara) • Steqeyma (ustekinumab-stba) • Selarsdi (ustekinumab-aekn) • Yesintek (ustekinumab-kfce) 08/01/2025 Biosimilar options are carefully reviewed and selected to provide choices based on individual product characteristics. See table on the next page for more details. Health Insurance Marketplace (HIM) formulary options have also been included for reference. Frequently asked questions Will I need to submit a new prescription for a biosimilar to the pharmacy? Yes, as a best practice. For example, all of the ustekinumab biosimilars are interchangeable, however, the pharmacy will need to know which product the prescriber would prefer to substitute.
Will I need to submit a new prior authorization for new biosimilar prescriptions? Existing reference brand approvals will be applied to all formulary biosimilars; however, all new starts and renewals will require a new prior authorization. What is the easiest way to order a biosimilar? Select the biosimilar best suited for your patient using the table below. If possible, include the 4-letter suffix to prevent confusion or clarification calls when ordering unbranded products (e.g., Adalimumab-aaty for unbranded Yuflyma). Will my patient be eligible to obtain the biosimilar product under a manufacturer copay assistance program? Yes. All new formulary options include manufacturer copay assistance programs with as little as $0 copays for member out-of-pocket costs. The patient’s current specialty pharmacy can assist with set-up. with manufacturer coupon Baylor Scott & White Health Plan Biosimilars Preferred Program Continued next page

Frequently asked questions, cont. What indications are biosimilars of Humira approved for? Biosimilars have been approved for the following indications: ankylosing spondylitis, Crohn’s disease, hidradenitis suppurativa, juvenile idiopathic arthritis, plaque psoriasis, psoriatic arthritis, rheumatoid arthritis, ulcerative colitis, and uveitis. Please refer to the product specific package insert for the most up-to-date information. What indications are biosimilars of Stelara approved for? All biosimilars have been approved for the same indications as the originator Stelara: Crohn’s disease in adults, ulcerative colitis in adults, plaque psoriasis (peds and adults), psoriatic arthritis (peds and adults). What is the coverage status for reference brand Stelara? Brand Stelara is excluded from pharmacy coverage on the Group Value Commercial Formulary (as of 8/1/2025) and on the BSWHP HIM Formulary (as of 1/1/2026) since it does not offer significant benefit over ustekinumab biosimilars. Do I need to order IV ustekinumab under the medical benefit? Yes, preferred IV biosimilars should be prescribed for loading doses under the medical benefit. BSWHP typically aligns preferred products across medical and pharmacy benefits. Biosimilars 2026 Formulary Information. Rx Selection in Epic or EMR Manufacturer Group Value/ Group Choice Formulary 2026 Health Insurance Marketplace Formulary 2026 Ustekinumab (Stelara) Biosimilars, Effective 8/1/25 Selarsdi (ustekinumab-aekn) Alvotech/Teva   Steqeyma (ustekinumab-stba) Celltrion   Yesintek (ustekinumab-kfce) Biocon   Brand Stelara Janssen 1 1 Adalimumab (Humira) Biosimilars, Effective 1/1/25 Hadlima (Adalimumab-bwwd) Organon Samsung Bioepis   Adalimumab-aaty (unbranded Yuflyma) Celltrion   Simlandi (Adalimumab-ryrk) Alvotech/Teva   Adalimumab-adaz (unbranded Hyrimoz) Sandoz —  Brand Humira Abbvie 1 2 1 Benefit exclusion 2 Only available for continuation of therapy for current users Rx-BiosimilarProgram1125-SE