Limited coverage drugs – infliximab

Biosimilar Transition Initiative

PharmaCare covers infliximab biosimilar products for rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), plaque psoriasis (PsO), and patients with inflammatory bowel disease (IBD) of either Crohn’s disease or ulcerative colitis.

As of:

• May 27, 2019 – all Special Authority (SA) requests and renewals for infliximab for RA, AS, PsA, and PsO patients are approved for either Renflexis or Inflectra.
• September 5, 2019 – SA requests or renewals for infliximab for adult IBD patients are only authorized for Renflexis or Inflectra
• February 18, 2021 – Avsola was added as a PharmaCare covered biosimilar to treat RA, AS, PsA, PsO and IBD patients

Special Authority requests for patients who are unable to transition to biosimilar infliximab will be considered on an exceptional case-by-case basis.

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Generic name	infliximab
Strength	100 mg/vial
Form	powder for solution

Avsola^™ or Inflectra^® or Renflexis^™

Special Authority criteria	Approval period
Treatment of rheumatoid arthritis according to established criteria when prescribed by a rheumatologist.	First approval: 1 year Renewal: 1 year to indefinite
Treatment of psoriatic arthritis according to established criteria when prescribed by a rheumatologist.	First approval: 1 year Renewal: 1 year to indefinite
Treatment of ankylosing spondylitis according to established criteria when prescribed by a rheumatologist.	First approval: 1 year Renewal: 1 year to indefinite
For the treatment of moderate to severe psoriasis according to established criteria, when prescribed by a dermatologist.	First approval (induction period): 3 doses Renewal: 1 year
Treatment of moderate to severe active Crohn's disease or fistulising Crohn's disease according to established criteria when prescribed by a gastroenterologist.	First approval (induction period): 3 doses Renewal: 1 year
Treatment of moderate to severe ulcerative colitis according to established criteria when prescribed by a gastroenterologist.	First approval (induction period): 3 doses Renewal: 1 year

Practitioner exemptions

• None

Special notes

• PharmaCare covers a maximum of 56 days per fill for infliximab. One infusion (dose) usually provides treatment for 56 days or less.

Special Authority request forms

• Log in to eForms​

Rheumatoid arthritis

• HLTH 5345 - Targeted DMARDs for Rheumatoid Arthritis: Initial/Switch (PDF, 453KB)
• HLTH 5354 - Targeted DMARDs for Rheumatoid Arthritis: Renewal (PDF, 399KB)
• HLTH 5383 - Health Assessment Questionnaire (HAQ) (PDF, 528KB)

Psoriatic arthritis

• HLTH 5360 - Targeted DMARDs for Psoriatic Arthritis: Initial/Switch (PDF, 241KB)
• HLTH 5361 - Targeted DMARDs for Psoriatic Arthritis: Renewal (PDF, 224KB)
• HLTH 5364 - Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) (PDF, 64KB)
• HLTH 5383 - Health Assessment Questionnaire (HAQ) (PDF, 528KB)

Ankylosing spondylitis

• HLTH 5365 - Targeted DMARDs for Ankylosing Spondylitis: Initial/Switch (PDF, 242KB)
• HLTH 5366 - Targeted DMARDs for Ankylosing Spondylitis: Renewal (PDF, 237KB)
• HLTH 5364 - Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) (PDF, 64KB)

Plaque psoriasis

• HLTH 5380 - Biologics for Moderate to Severe Psoriasis (PDF, 365KB)
• HLTH 5379 - Psoriasis Area and Severity Index (PASI) Worksheet (PDF, 529KB)

Crohn’s disease

• HLTH 5368 - Biologics for Moderate to Severe Active Crohn’s Disease (PDF, 779KB)
• HLTH 5495 - Biologics for Moderate to Severe Active Crohn's or Fistulizing Crohn's: Renewal (PDF, 607KB)
• HLTH 5374 - Worksheet (based on Harvey-Bradshaw Index) (PDF, 514KB)

Ulcerative colitis

• HLTH 5388 - Targeted DMARDs for Ulcerative Colitis: Initial/Renewal (PDF, 661KB)
• HLTH 5497 - Targeted DMARDs for Ulcerative Colitis: Renewal (PDF, 653KB)