Important Notification Regarding Infliximab

The Food and Drug Administration (FDA) has 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 the originator product, Remicade® (infliximab). Remicade and its biosimilar products, Infliximab AG (authorized generic), infliximab-axxq (Avsola™), infliximab-dyyb (Inflectra®) and infliximab-abda (Renflexis®) are part of the Blue Cross Blue Shield of North Dakota (BCBSND) Infliximab medical policy.

Effective January 1, 2023, BCBSND is updating the Infliximab medical policy. 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 which will be effective January 1, 2023.  The updated policy will be available for review on before September 1, 2022. Requests for Non-Preferred Agents received prior to September 1, 2022, that met current medical policy criteria will be given an adjusted approval until December 31, 2022. Requests for Non-Preferred Agents received on or after September 1, 2022, that meet current medical policy criteria will be approved until December 31, 2022.

To continue with a Non-Preferred Agent on or after January 1, 2023, Non-Preferred agent requests will need to be approved under the updated medical policy criteria.

Preferred Agents 
(effective 1/1/2023)

Non-Preferred Agent
(effective 1/1/2023)

Inflectra (infliximab-dyyb) - Q5103

Remicade (infliximab) - J1745

Renflexis (infliximab-abda) - Q5104

Avsola (infliximab-axxq) - Q5121

Infliximab AG - J1745