MedicaidPrior AuthMedium impact
Preferred Infliximab Products - Inflectra (infliximab-dyyb) (Revised)
Humana·KY · Rheumatology, Gastroenterology, Dermatology +1 more·Medicaid
We identified it
Jul 2, 2026
Summary
Humana Medicaid-Kentucky has revised its Prior Authorization policy for Preferred Infliximab Products, specifically Inflectra (infliximab-dyyb). This policy update affects coverage and authorization requirements for this biosimilar infliximab product for eligible Kentucky Medicaid members. Billing teams must verify current authorization requirements before submitting claims for this medication.
Action Required
Immediately: Billing team must obtain and review the complete revised policy from the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a56a5d0) to identify specific changes from the prior version. Update prior authorization workflows in billing software to reflect any new requirements for HCPCS code J1745 (Infliximab-dyyb injection). Notify providers administering infliximab products that authorization requirements may have changed. Confirm with Humana-Kentucky Medicaid whether prior authorization is required before dispensing or administration. Failure to follow updated authorization requirements will result in claim denials.