Effective April 1, 2022, Preferred Agent Change for Infliximab Medical Policy

The Food and Drug Administration (FDA) has recently approved biosimilar products that can be utilized in place of reference drugs in most clinical circumstances. Biosimilar products offer additional safe and cost-effective options. The FDA has approved several biosimilars for Remicade® (infliximab) including most recently approving Infliximab (unbranded Remicade). Remicade and its biosimilar products, Infliximab (unbranded Remicade), infliximab-axxq (AvsolaTM), infliximab-dyyb (Inflectra®) and infliximab-abda (Renflexis®) are part of the Blue Cross Blue Shield of North Dakota (BCBSND) Infliximab medical policy.

Effective 4/1/2022, BCBSND is updating the Infliximab medical policy to include preferred agents. Please see the table below for a list of preferred and non-preferred agents. Non-preferred agents that do not meet the updated medical policy criteria may not have benefit coverage and therefore may not be reimbursed. The Infliximab medical policy will be updated to reflect these changes and will be available for review on bcbsnd.com before 4/1/2022. Requests for Renflexis received prior to February 1, 2022, that met medical policy criteria will be given an adjusted approval until March 31, 2022. Requests for Renflexis received after February 1, 2022, that meet medical policy criteria will be approved until March 31, 2022.

On or after April 1, 2022, Renflexis requests will need to be approved under the updated medical policy criteria.

Preferred Agents

Non-Preferred Agent

Avsola (infliximab-axxq) - Q5121
Inflectra (infliximab-dyyb) - Q5103
Remicade (infliximab) - J1745
Infliximab - J1745

Renflexis (infliximab-abda) - Q51049