Biosimilars preferred over Remicade® effective July 1

Beginning July 1, 2018, Priority Health will be preferring the use of biosimilar infliximab products over Remicade® for commercial, individual and Medicaid products.

Rationale

Priority Health has covered the use of Remicade® (infliximab) for a variety of autoimmune disorders since its approval by the FDA in 1999. The biosimilar infliximab products Inflectra™ (infliximab-dyyb), and Renflexis™ (infliximab-abda) were approved by the FDA in 2016 and 2017, respectively.

Today, with two biosimilars on the market, there is now healthier competition and established ASP pricing, making coverage of the biosimilar products more economically favorable. Remicade® typically is used in the treatment of rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn's disease, plaque psoriasis, or ulcerative colitis.

See the video on biosimilars (13 min.)

For patients currently on Remicade

Affected providers and members will receive a letter outlining the following changes in the coming weeks.

All existing approvals for Remicade® (J1745) will be given a June 30, 2018 end date.

We will enter authorizations for the biosimilar inflixumab products to replace any remaining doses on current authorizations - the same dose, frequency, location, and approval dates will apply. Providers do not need to complete new prior authorization requests for patients who have existing infliximab approvals on file.

  • No new approval letter will be sent when we update the authorization.
  • Providers may choose to prescribe either Inflectra™ or Renflexis™.

Beginning July 1

Remicade® infusions will not be covered.

Providers need to request prior authorization for a biosimilar inflixumab product for patients starting infliximab infusions on or after July 1, 2018.

Billable codes

Inflectra™

HCPCS code Q5103, Injection, infliximab, biosimilar, 10 mg

Renflexis™

HCPCS code Q5104, Injection, infliximab, biosimilar, 10 mg