We're removing prior authorization requirements for infliximab

Effective May 6, 2020, we’re removing prior authorization requirements for infliximab products for commercial group and individual plans.

Site of service restrictions still apply

Site of service restrictions for infliximab will still apply. For commercial group and individual products, we require patients to have infliximab injections in the home or office setting, or an alternative Priority Health-approved site of service.

For more information, reference medical policy 91414

Background

Infliximab products are a medical injectable typically used to treat a variety of autoimmune disorders.

We cover two infliximab products, InflectraTM and RenflexisTM, which are biosimilars for the drug Remicade, and are the preferred drugs for our commercial (traditional and optimized) formularies.

Why are we making this change?

We’re lifting the requirement due to biosimilar competition driving down drug prices and to reduce administrative burden of prior authorizations.