MedicaidPrior AuthHigh impact
Non-Preferred Infliximab Products - Renflexis (infliximab-abda), Avsola (infliximab-axxq), Remicade (infliximab), unbranded Infliximab (Revised)
Humana·KY · Rheumatology, Gastroenterology, Internal Medicine·Medicaid
We identified it
Jul 2, 2026
Summary
This is a new Prior Authorization policy for non-preferred infliximab products (Renflexis, Avsola, Remicade, and unbranded infliximab) for Kentucky Medicaid members. The policy establishes coverage requirements and prior authorization procedures for these TNF inhibitor medications, which are commonly used in rheumatologic and gastroenterologic conditions.
Action Required
Immediately: Billing team must implement prior authorization requirements for all infliximab products (Renflexis-infliximab-abda, Avsola-infliximab-axxq, Remicade-infliximab, and unbranded infliximab) for Kentucky Medicaid patients. Update billing software and encounter forms to flag these medications for prior auth submission before claims are processed. Contact Humana Medicaid Kentucky directly using the policy reference (090009298a56a5d2) to obtain specific clinical criteria, required documentation, and submission procedures. Verify patient plan eligibility in the system. Failure to obtain prior authorization will result in claim denials. Review the full policy details at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a56a5d2 to identify any coverage limitations or preferred alternatives.