We want to make you aware of the important updates for members and clients transitioning to the biosimilar-first formularies, Essential Direct and National Direct Preferred, effective from July 1, 2025. Humira and Stelara: Claims for Humira or Stelara will be rejected as non-formulary for clients implementing these formularies from July 1, 2025. An authorization will be preloaded for the preferred biosimilar, matching the original prior authorization's dates. For members opting out of the preferred biosimilar or if their provider doesn’t approve the switch to a preferred biosimilar, a non-formulary exception request must be submitted, explaining why the biosimilar can’t be used. Non-preferred biosimilars, including Adalimumab-adbm and High WAC Cyltezo: An authorization for the preferred biosimilar will also be aligned with original prior authorization dates. Specialty pharmacies will contact providers to switch members using non-preferred biosimilars to a preferred version. If the prescriber doesn’t approve the switch to the preferred biosimilar, the existing medication can be given until the current authorization expires. If you have questions, please reach out to your CarelonRx clinical account director or pharmacist program manager.