Aetna Commercial's January 2027 changes: bevacizumab, trastuzumab, checkpoint inhibitors and more
Eight classes of infusion-center biologics change on January 1. Four bevacizumab and trastuzumab products change status for one site of care only.
The short version
If you infuse Alymsys, Kanjinti, Neulasta or Panzyga for Aetna commercial members, plan the switch now. Each moves to non-preferred on January 1, or at renewal for some fully insured plans (see below). Aetna says prior authorizations already in place stay valid until they expire, and that it has told affected patients to talk with their prescriber about a preferred alternative.
What moves
| Drug class | Becomes preferred | Becomes non-preferred |
|---|---|---|
| Bevacizumab | Zirabev; Vegzelma (home or office only) | Alymsys; Mvasi (outpatient hospital only) |
| Trastuzumab | Ontruzant; Ogivri (home or office only) | Kanjinti; Trazimera (outpatient hospital only) |
| Pertuzumab | Perjeta | — |
| Long-acting G-CSF | — | Neulasta |
| Immune globulin (IVIG) | Gamunex-C | Panzyga |
| Multiple sclerosis (infused) | Tyruko* | — |
| Severe asthma | Omlyclo* | — |
| Checkpoint inhibitors | Changes by indication. See below. | |
* On Aetna's Combined Benefit Management list. For members with both Aetna fully insured medical and pharmacy benefits, these drugs may be available under only one of the two benefits. The notice names Neulasta without listing Neulasta Onpro separately. It also changes two products outside this summary: certain bendamustine NDCs and the retinal drug Lytenava.
Four products change for one site of care
Aetna ties four of these changes to where the drug is given. Mvasi becomes non-preferred only in the outpatient hospital setting, and Vegzelma becomes preferred only for home or office. Trastuzumab is split the same way: Trazimera becomes non-preferred for outpatient hospital, and Ogivri becomes preferred for home or office. Zirabev and Ontruzant become preferred with no site limitation, which makes them the simplest choice for an organization that infuses in more than one setting.
Checkpoint inhibitors change indication by indication
The checkpoint changes are the largest part of the notice. Both subcutaneous products, Keytruda Qlex and Opdivo Qvantig, move to non-preferred for every indication the notice lists for them, but several IV products lose indications too.
- Keytruda becomes preferred for esophageal, gastric and urothelial cancer, and for neoadjuvant non-small cell lung cancer.
- Keytruda Qlex becomes non-preferred for twelve indications, including melanoma, renal, urothelial, endometrial, and adjuvant, metastatic and neoadjuvant non-small cell lung cancer.
- Opdivo becomes preferred for esophageal, gastric and urothelial cancer, becomes non-preferred for neoadjuvant non-small cell lung cancer, and moves from preferred to non-preferred for renal cancer.
- Opdivo Qvantig becomes non-preferred for esophageal, gastric, urothelial and neoadjuvant non-small cell lung cancer, and moves from preferred to non-preferred for renal cancer.
- Imfinzi becomes preferred for neoadjuvant non-small cell lung cancer, and Tecentriq becomes preferred for extensive-stage small cell lung cancer.
- Bavencio becomes non-preferred for urothelial cancer, and Tevimbra for esophageal and gastric cancer.
Who it applies to
Aetna commercial medical plans only. The notice says it does not apply to Aetna's Medicare or Medicaid plans. For fully insured commercial plans, including HMOs, in Louisiana, New York, Texas and, in most circumstances, Connecticut, the changes take effect at the plan's renewal date rather than on January 1.
What to do before January 1
- Pull Aetna commercial patients on Alymsys, Kanjinti, Neulasta, Panzyga, Mvasi or Trazimera with infusions scheduled after January 1, and note when each authorization expires.
- For bevacizumab and trastuzumab patients, confirm the site of care, because the preferred product differs by setting.
- For checkpoint inhibitor patients, check the indication on the order against the list above, especially for anyone on Keytruda Qlex or Opdivo Qvantig.
- Update order sets and authorization templates so new starts default to the preferred product.
Source: Aetna, changes coming to the commercial medical plan drug lists, January 1, 2027. Summarized by Beacana; confirm with the payer before relying on it for a specific authorization.