Remicade® (infliximab)

Authorization forms

Medicare Part D (09/2018)

Medicare Part B (01/2019)

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.

Read the news article

See the video presentation on biosimilars (13 min.)

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