Remicade® (infliximab)
Authorization forms
Remicade is not covered for Traditional, Optimized or Medicaid
July 1 change: Remicade® infusions no longer covered
All existing approvals for Remicade (J1745) will be given a June 30, 2018 end date.
No prior authorization required for:
- Emergency room
- Inpatient
- Skilled nursing facility
Injectable auth/billing notes:
Medications billed with miscellaneous codes will be reviewed. Explanatory notes must accompany the claim.
Priority Health Medicare applies CMS local coverage determination criteria when available for Part B drugs.
Code(s): J1745
Benefit: Medical
Notes: Per 10 mg; for treatment of rheumatoid arthritis, ankylosing spondylosis, Crohn’s disease, ulcerative colitis, plaque psoriasis, psoriatic arthritis, or ankylosing spondylitis