CommercialCoverageMedium impact
08.00.34v, Intravenous Infliximab and Related Biosimilars
Independence Blue Cross·Gastroenterology, Rheumatology, Oncology·Pharmacy
Effective date
Apr 21, 2025
We identified it
Jun 19, 2026
Summary
Medical necessity criteria for intravenous infliximab and related biosimilar medications have been updated for commercial insurance plans. This affects billing and coverage requirements for these high-cost specialty medications used primarily in gastroenterology and rheumatology.
Action Required
By April 21, 2025: Billing team must review updated medical necessity criteria for intravenous infliximab and biosimilars. Update prior authorization workflows and ensure providers document required medical necessity elements before administering these medications. Verify coverage criteria with commercial payers to prevent claim denials.