MedicaidPrior AuthHigh impact
Non-Preferred Infliximab Products - Renflexis (infliximab-abda), Avsola (infliximab-axxq), Remicade (infliximab), unbranded Infliximab (Revised)
Humana·SC · Rheumatology, Gastroenterology, Dermatology +1 more·Medicaid
We identified it
Jul 2, 2026
Summary
Humana has revised its prior authorization policy for non-preferred infliximab products (Renflexis, Avsola, Remicade, and unbranded infliximab) effective immediately for South Carolina Medicaid members. This policy change requires prior authorization before dispensing these biosimilar and reference products, which may impact claims processing and patient access timelines.
Action Required
Immediately: Billing team must implement prior authorization requirement for all infliximab products (J1745 - Remicade/Renflexis/Avsola/unbranded infliximab) for South Carolina Medicaid members before claims submission. Update billing system to flag these claims for mandatory prior auth submission to Humana. Inform providers and pharmacy staff that infliximab infusions cannot proceed without pre-approval. Establish process to obtain authorization from Humana before treatment administration. Failure to obtain prior authorization will result in claim denials and may delay patient treatment.