Medicare AdvantagePrior AuthHigh impact
Non-Preferred Infliximab Products - Renflexis (infliximab-abda), Avsola (infliximab-axxq) (Revised)
Humana·Rheumatology, Gastroenterology, Dermatology·Medicare Advantage
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage updated prior authorization requirements for non-preferred infliximab biosimilars Renflexis and Avsola, requiring step therapy through preferred infliximab products (Remicade, Inflectra, unbranded infliximab) and additional medications before approval. The policy covers multiple autoimmune conditions including rheumatoid arthritis, Crohn's disease, ulcerative colitis, and psoriasis with specific age and clinical criteria.
Action Required
Immediately: Update prior authorization protocols for Renflexis and Avsola infusions. Billing team must verify patients have failed preferred infliximab products (Remicade, Inflectra, unbranded infliximab) before submitting PA requests. For certain conditions, also verify failure of ustekinumab products (Stelara, Otulfi, Yesintek) or Tremfya. Providers must document step therapy failures and contraindications in medical records. Claims will be denied without proper prior authorization and documentation of required step therapy.