CommercialPrior AuthHigh impact
Non-Preferred Infliximab products - Renflexis (infliximab-abda) and Avsola (infliximab-axxq) (Revised)
Humana·Rheumatology, Gastroenterology, Dermatology·Commercial
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
Humana has updated prior authorization requirements for non-preferred infliximab biosimilars Renflexis and Avsola across multiple conditions including rheumatoid arthritis, inflammatory bowel disease, and psoriasis. These drugs now require failure of preferred infliximab products (Remicade, Inflectra, unbranded infliximab) before approval, with additional step therapy requirements for certain conditions.
Action Required
Immediately: Update prior authorization protocols for Renflexis and Avsola to document required step therapy with preferred infliximab products first. Billing team must verify patients have failed Remicade, Inflectra, or unbranded infliximab before submitting prior auth requests. For Crohn's disease, ulcerative colitis, psoriatic arthritis, and plaque psoriasis cases, also document Stelara trial/contraindication/intolerance. Update EMR templates to capture required failure documentation. Claims will be denied without proper step therapy documentation.