Start transitioning adult BCN HMO members using infliximab products to Inflectra^®

Starting May 1, 2019, Blue Care Network prefers the infliximab product, Inflectra (infliximab-dyyb), for its adult BCN HMO^SM (commercial) members. This change doesn't apply to:

• Members covered by any other line of business, including BCN Advantage^SM and Blue Cross PPO (commercial) members
• Pediatric members 15 years old or younger
• Pediatric members 18 years old or younger weighing 50 kg or less

Please refer to the current medical policy for all criteria, and begin taking steps to:

• Transition adult members with active authorizations for non-Inflectra infliximab products to Inflectra by May 1, 2019.
• Prescribe or fill Inflectra when possible instead of Remicade^® (infliximab), HCPCS code J1745, or Renflexis^® (infliximab-abda), HCPCS code Q5104.
• Bill Inflectra with HCPCS code Q5103.

Quick links to helpful resources:

• Current Medical Policy search tool. Search for "Inflectra" using the Keyword/Phrase search field.
• Requirements for drugs covered under the medical benefit (BCN HMO and Blue Cross PPO)

Posted: February 2019
Line of business: Blue Care Network