Effective November 1, Inflectra^® is the preferred infliximab product for adult Blue Cross' PPO (commercial) members

Please note that this message replaces the previous message we posted on July 30 and then promptly removed. Please refer to the web-DENIS message titled "Clarification: Preferred infliximab strategy for adult Blue Cross' PPO (commercial) members" that we posted on August 8 regarding the updates to this article.

Starting Nov. 1, 2019, Inflectra (infliximab-dyyb; HCPCS Code Q5103) will be the preferred infliximab product for its adult Blue Cross' PPO (commercial) members.

Action required

As of Nov. 1, 2019, adult Blue Cross' PPO (commercial) members with an active authorization for an infliximab product other than Inflectra must transition to Inflectra.

The infliximab products other than Inflectra are:

• Remicade^® (infliximab) - HCPCS code J1745
• Renflexis^® (infliximab-abda) - HCPCS code Q5104

The authorization requirements apply only to groups that are currently participating in the standard commercial Medical Drug Prior Authorization Program for drugs administered under the medical benefit.

This change doesn't apply to:

• Blue Cross' pediatric members 15 years old or younger
• Blue Cross' pediatric members 18 years old or younger weighing 50 kg or less
• Any member covered by Medicare Plus Blue^SM PPO, BCN Advantage^SM or the Federal Employee Program^®.

Note: This change took effect for BCN HMO^SM (commercial) members on May 1, 2019.

Quick links to helpful resources

• Current Medical Policy search tool. Enter "Inflectra" in the Policy / Topic Keyword field, click Search and click the PDF icon for MEDICAL POLICY - INFLIXIMAB: REMICADE (J1745), RENFLEXIS (Q5104), INFLECTRA (Q5103).
• Requirements for drugs covered under the medical benefit (BCN HMO and Blue Cross PPO)

Note: The Inflectra change will be reflected in the requirements list on November 1.

Posted: July 2019
Line of business: Blue Cross Blue Shield of Michigan