Limited Coverage Drugs - Infliximab

BIOSIMILAR TRANSITION INITIATIVE

PharmaCare is changing coverage of infliximab products for rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PA), plaque psoriasis (PS), and patients with either Crohn’s disease or ulcerative colitis (gastrointestinal indications (GI)).

RA, AS, PA, PS, and GI patients currently using Remicade® must switch 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, AS, PA, and PS patients are approved for either Renflexis or Inflectra.

Remicade patients for these indications 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. When a SA is renewed during the transition time only the Renflexis or Inflectra brands are authorized for continued coverage.

Effective September 5, 2019, adult patients using Remicade for gastrointestinal indications (GI) – ulcerative colitis or Crohn’s disease – must switch to Renflexis or Inflectra before March 6, 2020. All three brands will be covered for patients with existing SA approval during the transition period beginning September 5, 2019 until March 5, 2020, when Remicade coverage for adult GI patients ends. When a SA is renewed during the transition time only the Renflexis or Inflectra brands are authorized for continued coverage.

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 (for non-GI indications) and before March 6, 2020 (for GI indications) to ensure continued coverage.

 

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

  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