CommercialPrior AuthMedium impact
November 2026 Drug List Change Notification (Commercial)
PacificSource Health Plans·Rheumatology, Gastroenterology, Dermatology +1 more·Prior Authorization
Effective date
Nov 30, 2026
We identified it
Oct 7, 2026
Summary
Effective November 30, 2026, PacificSource is adding six infliximab-based biologic medications (Remicade, Zymfentra, Inflectra, Renflexis, Ixifi, and Avsola) to its Infusion Services Site of Care prior authorization criteria for commercial plans. Billing teams must implement prior authorization requirements for these six HCPCS codes before the effective date.
Action Required
By November 30, 2026: Billing team should update the billing system and prior authorization workflows to require prior authorization for infusion services when claims include HCPCS codes J1745 (Remicade), J1748 (Zymfentra), Q5103 (Inflectra), Q5104 (Renflexis), Q5109 (Ixifi), or Q5121 (Avsola) for PacificSource commercial members. Verify the current PacificSource Drug Lists page for complete criteria details and confirm implementation before November 30, 2026 to prevent claim denials for these medications.