Changes coming to preferred products for infliximab (reference product Remicade^®) for Medicare Advantage members, starting April 1

For dates of service on or after April 1, 2022, we're making the following changes to the medications designated as preferred and nonpreferred infliximab products (reference product Remicade):

• Preferred products:
  • Inflectra^® (infliximab-dyyb), HCPCS code Q5103
  • Avsola^® (Infliximab-axxq), HCPCS code Q5121
• Nonpreferred products:
  • Remicade^® (infliximab), HCPCS code J1745
  • Renflexis^® (infliximab-abda), HCPCS code Q5104

This change affects Medicare Plus Blue^SM and BCN Advantage^SM members.

Here's what you need to know when prescribing these products:

• For members who start treatment on or after April 1: Prescribe preferred products when possible. These products don't require prior authorization.
• For members who receive nonpreferred products for courses of treatment that start before April 1: Please transition to a preferred product by April 1.

All nonpreferred products, including Renflexis, require prior authorization for dates of service on or after April 1, 2022.

Submitting requests for prior authorization

Here's how to submit prior authorization requests for preferred products and for nonpreferred products.

• Preferred products: Preferred products don't require prior authorization. Don't submit a request.
• Nonpreferred products, for members who must take them: Submit the prior authorization request through the NovoLogix^® online tool. NovoLogix offers real-time status checks and immediate approvals for certain medications. If you have access to Provider Secured Services, you already have access to enter authorization requests through NovoLogix. If you need to request access to Provider Secured Services, complete the Provider Secured Access Application (PDF) form and fax it to the number on the form.

List of requirements

For a list of requirements related to drugs covered under the medical benefit, please see the Medical Drug and Step Therapy Prior Authorization List for Medicare Plus Blue PPO and BCN Advantage members (PDF).

We'll update the list to reflect this change prior to the effective date.

Posted: January 2022
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network