MedicaidPrior AuthHigh impact
Non-Preferred Infliximab Products - Renflexis (infliximab-abda), Avsola (infliximab-axxq), Remicade (infliximab), unbranded Infliximab (Revised)
Humana·SC · Rheumatology, Gastroenterology, Dermatology·Medicaid
Effective date
Jul 1, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicaid South Carolina has established prior authorization requirements for non-preferred infliximab products (Renflexis, Avsola, Remicade, and unbranded infliximab). All patients must fail or have intolerance to Inflectra (preferred product) before these alternatives can be approved for various autoimmune conditions.
Action Required
Immediately: For all Humana Medicaid SC patients requiring infliximab therapy, billing team must obtain prior authorization before administering Renflexis, Avsola, Remicade, or unbranded infliximab. Providers must document failure or intolerance to Inflectra as preferred first-line therapy. Update prior authorization tracking system to include these requirements. Claims will be denied without proper prior authorization.