MedicaidPrior AuthMedium impact
Preferred Infliximab Products - Inflectra (infliximab-dyyb) (Revised)
Humana·KY · Rheumatology, Gastroenterology, Dermatology +1 more·Medicaid
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
Humana updated their Medicaid prior authorization policy for Inflectra (infliximab-dyyb), a biosimilar to Remicade, establishing specific criteria for approval across multiple conditions including rheumatoid arthritis, Crohn's disease, ulcerative colitis, and other inflammatory conditions. The policy prohibits combination therapy with other biologics and requires prior therapy with conventional treatments before approval.
Action Required
Before prescribing Inflectra for Kentucky Medicaid patients: Providers must ensure patients meet condition-specific criteria including age requirements, prior conventional therapy trials, and document contraindications to first-line treatments. Billing team must verify prior authorization approval before infusion scheduling. Claims will be denied without proper prior authorization meeting the detailed criteria outlined in the policy.