Medicare AdvantagePrior AuthHigh impact
Preferred Infliximab Products - Remicade (infliximab), Inflectra (infliximab-dyyb), and infliximab (Revised)
Humana·Rheumatology, Gastroenterology, Dermatology·Medicare Advantage
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated prior authorization requirements for infliximab products (Remicade, Inflectra, and unbranded infliximab) across multiple conditions including rheumatoid arthritis, Crohn's disease, ulcerative colitis, ankylosing spondylitis, psoriatic arthritis, and plaque psoriasis. The policy includes specific age requirements, prior therapy criteria, and exclusions for combination biologic therapy.
Action Required
Immediately: Billing and clinical teams must implement prior authorization protocols for all infliximab products (Remicade, Inflectra, unbranded infliximab) for Humana Medicare Advantage patients. Update EMR templates to document required criteria including age verification, prior therapy history, and contraindications. Ensure providers document prohibition of combination biologic therapy. Claims will be denied without proper prior authorization approval.