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.


Generic Name

infliximab

Strength

100 mg/vial

Form

powder for solution

Avsola or Inflectra® or Renflexis

Special Authority Criteria

Approval Period

  1. Treatment of rheumatoid arthritis according to established criteria when prescribed by a rheumatologist.

First approval: 1 year
Renewal: 1 year to indefinite

  1. Treatment of psoriatic arthritis according to established criteria when prescribed by a rheumatologist.

First approval: 1 year
Renewal: 1 year to indefinite

  1. Treatment of ankylosing spondylitis according to established criteria when prescribed by a rheumatologist.

First approval: 1 year
Renewal: 1 year to indefinite

  1. 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

  1. 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

  1. 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

Rheumatoid arthritis

Psoriatic arthritis

Ankylosing spondylitis

Plaque psoriasis

Crohn’s disease

Ulcerative colitis