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Priority Health - Biosimilars preferred over Remicade as of July 1

May 14, 2018

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

Prior to July 1:

  • A new prior auth (PA) will not be required for current Remicade patients.
    • All existing approvals for Remicade (J1745) will be given a 06/30/2018 end date and authorizations for the biosimilar products will be entered to replace any remaining doses on current authorizations - the same dose, frequency, location, and approval dates will apply.
    • No new prior authorization needs to be completed for patients who have existing infliximab approvals on file, and no new approval letter will be sent when we update the authorization. Providers may choose to prescribe either infliximab product (Inflectra or Renflexis). Remicade infusions given after 06/30/2018 will NOT be covered.
  • Members and providers will receive communication discussing the biosimilar transition.

After July 1:

  • Any patient who is new to start an infliximab product after July 1, 2018 will first need a prior authorization.

 

Billable codes

Product Name HCPCS Code
Remicade J1745 Injection, infliximab, excludes biosimilar, 10 mg
Inflectra Q5103 Injection, infliximab, biosimilar, 10 mg
Renflexis Q5104 Injection, infliximab, biosimilar, 10 mg

 

Our medical leadership, clinical pharmacists and Pharmacy and Therapeutics Committee (comprised of network physicians), have discussed and reviewed the research and results. All agree and are confident in biosimilars being an appropriate replacement for Remicade. 

Thank you ,

Priority Health