MedicaidPrior AuthMedium impact
Non-Preferred Infliximab Products - Renflexis (infliximab-abda), Avsola (infliximab-axxq), Remicade (infliximab), unbranded Infliximab (Revised)
Humana·KY · Rheumatology, Gastroenterology, Dermatology·Medicaid
Effective date
Jun 25, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Kentucky updated its prior authorization policy for non-preferred infliximab products (Renflexis, Avsola, Remicade, and unbranded infliximab) with a revision date of June 25, 2025. All patients must fail or have intolerance to Inflectra before these non-preferred infliximab products can be approved for various inflammatory conditions including rheumatoid arthritis, Crohn's disease, ulcerative colitis, ankylosing spondylitis, psoriatic arthritis, and plaque psoriasis.
Action Required
By June 25, 2025: Billing team must ensure prior authorization requests for Renflexis, Avsola, Remicade, or unbranded infliximab include documentation that patient has failed or is intolerant to Inflectra for all Kentucky Medicaid patients. Update prior auth forms and provider checklists to include Inflectra trial requirement. Providers must document specific symptom control failure or intolerance to Inflectra in medical records. Claims will be denied without proper documentation of Inflectra failure.