MedicaidPrior AuthMedium impact
Preferred Infliximab Products - Inflectra (infliximab-dyyb) (Revised)
Humana·SC · Rheumatology, Gastroenterology, Infectious Disease·Medicaid
We identified it
Jul 2, 2026
Summary
Humana has revised its Prior Authorization policy for Inflectra (infliximab-dyyb), a preferred infliximab biosimilar product for South Carolina Medicaid members. This policy update affects coverage and authorization requirements for this biologic medication, commonly used in rheumatology and gastroenterology practices.
Action Required
Immediately: Billing team must obtain the full policy document from the provided URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a56a5ce) to identify specific prior authorization requirements, approved indications, and any changes from the previous policy version. Update billing software and prior auth submission templates to reflect new requirements for J1745 (Infliximab) claims for South Carolina Medicaid members. Providers should be notified of any changes to documentation requirements or step-therapy protocols. Failure to follow updated prior auth requirements will result in claim denials for Inflectra administration.