In an effort to reduce costs while maintaining high safety, efficacy and quality standards we will require use of the biosimilar Inflectra, in place of Remicade® and RenflexisTM, when infliximab is being used to treat rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn's disease, plaque psoriasis, adult ulcerative colitis and other compendium supported diagnoses for members enrolled in commercial, Exchange and Medicaid managed care lines of business
This change is effective February 1, 2018 for new starts and April 1, 2018 for individuals who have already been approved for Remicade. You may begin prescribing Inflectra starting January 1.
Prior authorization is not required for members enrolled in commercial, Exchange and Medicare lines of business.
While use of Inflectra is not required for Medicare members, we strongly encourage prescribing Inflectra when medically appropriate. When treating pediatric ulcerative colitis, Inflectra is not required, but can be prescribed when it is determined to be the best course of therapy.
We will notify members who have received an infusion of Remicade in the last four months. If you have patients affected by this change, you will be notified
Inflectra is a Biosimilar to Remicade
A biosimilar product is a biologic product that is approved based on demonstrating that it is highly similar to a FDAapproved biologic product, known as a reference product, and has no clinically meaningful differences in terms of safety and effectiveness from the reference product. Only minor differences in clinically inactive components are allowed in biosimilar products.
To learn more about biosimilars, please visit the FDA’s website, www.fda.gov/biosimilars. The FDA website also provides resources for patients; we encourage you to review these materials before prescribing Inflectra.
Prescribing & Billing Requirements
To ensure prescribing accuracy and correct claim submissions, please follow the prescribing and billing requirements outlined on the reverse of this page. Please share this important information with your billing office/billing service and anyone within your practice who should be aware.
- Medicaid managed care and Child Health Plus members who have already been approved for use of Remicade or Renflexis will not need a prior authorization submitted for Inflectra. These authorizations will be transferred to Inflectra for the remaining approval time frame.
- All Medicaid managed care and Child Health Plus new starts will require a prior authorization for Inflectra. Please visit our website, provider.athg.excellusbcbs.com/authorizations, to obtain forms to fax your prior authorization requests for submission to Envolve - New York, Inc.
Resources & Support
- Pfizer enCompass can assist patients with identifying affordability options (i.e., patient assistance, cost share assistance) and help patients identify alternate funding options.
- Pfizer enCompass offers a complete guide to navigating the coding and billing process when submitting claims for Inflectra. To learn more, visit www.pfizerpro.com/product/inflectra/hcp/support/reimbursement-and-support.
- To contact the Pfizer enCompass program, call 1-844-722-6672, Monday through Friday, 9 a.m. to 8 p.m. EST.
- Your Provider Relations representative is also available to answer any questions you may have about this change and they can connect you with one of our pharmacists or medical directors to discuss any clinical questions you may have.
Thank you for your continued participation and for the quality of care and service you provide to your patients, our valued members.Email this article