MA Prescription Coverage Update: Humira and Stelara Will Not Be Preferred in 2026

Starting Jan. 1, 2026, Highmark will transition coverage of high-cost, brand-name drugs Humira and Stelara, along with related biosimilars, to lower-cost, equivalent medications for Medicare Advantage (MA) members.

This transition enables Highmark to provide members with effective alternatives that can lower their out-of-pocket costs. In most cases, pharmacies can dispense the biosimilar version without needing a new prescription.

With Highmark changing its formulary to prefer the biosimilars listed in the chart below for 2026, all existing authorizations for Humira, Cyltezo, Hyrimoz, Adalimumab, Stelara, Selarsdi, and Ustekinumab will be terminated effective Dec. 31, 2025. To make this transition easier, Highmark has already approved an authorization for all 2026 covered preferred biosimilar(s), which is effective immediately.

If there is a medical reason for a member to continue to receive their current prescription instead of switching to a covered biosimilar, a provider must submit a request for a new coverage determination.

2026 MA Prescription Coverage Update for Humira and Stelara