DISCONTINUED COVERAGE FOR TERSERA THERAPEUTICS LLC DRUGS EFFECTIVE MAY 14, 2022: UPDATE FOR METROPLUSHEALTH MEDICAID MANAGED CARE, PARTNERSHIP IN CARE (PIC) HIV-SNP, AND ENHANCED (HARP) PLAN MEMBERS
TerSera Therapeutics LLC voluntarily withdrew from participation in the Medicaid Drug Rebate Program (MDRP). As instructed by NY State Department of Health, effective May 14, 2022, MetroPlusHealth can no longer provide coverage for most drugs manufactured by TerSera Therapeutics LLC.
Pursuant to Social Security Law Sec. 1927 [42 U.S.C. 1396r-8] (a), Centers for Medicare and Medicaid Services (CMS) requires drug manufacturers to participate in the MDRP for their drugs to be eligible for coverage under Medicaid, except in certain circumstances. ZOLADEX® (goserelin implant) is a practitioner-administered drug manufactured by TerSera Therapeutics LLC which is available through a Patient Assistance Program (PAP) from the manufacturer free of charge for those who qualify. For program applications and additional information, providers must visit the ZOLADEX® “Access and support” web page or contact TerSera Support Source at (855) 686-8725.
Coverage of ZOLADEX® will continue to be provided for Medicaid members who are unable to obtain the medication through the PAP and when used under the following conditions:
- for a Food and Drug Administration (FDA)-approved indication for which there are no alternative options and
- as a continuation of established therapy if another gonadotropin-releasing hormone (GnRH) product has been tried and failed or if transition to another GnRH is medically contraindicated.
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