Limited Coverage Drugs - Infliximab

Limited Coverage Drugs ―infliximab

BIOSIMILAR TRANSITION INITIATIVE

PharmaCare is changing coverage of infliximab products for rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PA), and plaque psoriasis (PS) patients.

  • RA, AS, PA, and PS patients currently using Remicade® must transition to Renflexis™ or Inflectra® (in consultation with their prescriber) to maintain PharmaCare coverage.
  • As of May 27, 2019 all Special Authority (SA) requests and renewals for infliximab for RA, AP, PA, and PS patients will be approved for either Renflexis or Inflectra.
  • Remicade patients who wish to maintain PharmaCare coverage must transition to Renflexis or Inflectra before November 26, 2019. All three brands will be covered for patients with existing SA approval during the transition period beginning May 27, 2019  until November 25, 2019 when Remicade coverage for RA, AS, PA, ad PS patients ends.
  • To maintain patients’ coverage, prescribers must write a new prescription for their Remicade patients, indicating the transition to Renflexis or Inflectra. The patient’s existing infliximab SA remains in effect until the next renewal date, and no new SA request is required for coverage of the biosimilar.
  • For patients who are medically unable to transition, you can submit a new SA request for exceptional coverage of Remicade, which will be reviewed by Special Authority on a case-by-case basis. This request must be submitted before November 26, 2019 to ensure continued coverage.
  • Coverage for patients using Remicade for Crohn’s disease or ulcerative colitis will change during Phase 2 of the Biosimilars Initiative.  Phase 2 will begin later in the summer of 2019. Additional information will be provided to support Phase 2.

 

Generic Name

infliximab

Strength

100 mg/vial

Form

Powder for solution

Inflectra® or Renflexis™

 

Special Authority Criteria

Approval Period

  1. For the treatment of Rheumatoid Arthritis according to established criteria when prescribed by a rheumatologist.

First approval: 1 year
Renewal: 1 year to indefinite

  1. For the treatment of Psoriatic Arthritis according to established criteria when prescribed by a rheumatologist.

First approval: 1 year
Renewal: 1 year to indefinite

  1. For the 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

Inflectra®  Renflexis™ Remicade® 

 

Special Authority Criteria

Approval Period

  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

  • Pediatric gastroenterologists
  • Pediatric rheumatologists

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