CommercialCoverageMedium impact
Coverage changes for Remicade and biosimilars
Harvard Pilgrim Health Care·Rheumatology, Gastroenterology, Dermatology·Provider Newsletter
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Effective January 1, 2026, Point32Health (Harvard Pilgrim and Tufts plans) will make Avsola and Inflectra the preferred infliximab products, while Remicade and unbranded infliximab will become non-preferred. Commercial members currently on Remicade can switch to preferred products without new prior authorization, but Medicare members will only be affected if starting treatment after the effective date.
Action Required
Before January 1, 2026: Billing team must update systems to reflect Avsola and Inflectra as preferred infliximab products for Point32Health plans. Review current patients on Remicade (J1745) and coordinate with providers to transition commercial patients to preferred biosimilars without requiring new prior authorization. Update encounter forms and billing protocols to prioritize Avsola and Inflectra for new infliximab prescriptions. For Medicare patients, apply changes only to those starting treatment after Jan 1, 2026.