CommercialCoverageHigh impact
Remicade authorizations with end dates no later than December 31, 2022
Blue Cross Blue Shield of Rhode Island·RI · Rheumatology, Gastroenterology, Dermatology·Physician
Effective date
Jan 1, 2023
We identified it
Jun 19, 2026
Summary
BCBSRI will no longer cover Remicade for commercial members starting January 1, 2023, replacing it with biosimilar products Avsola and Inflectra which require no authorization. Medicare members can still receive Remicade but new requests after January 1, 2023 must try biosimilars first unless a coverage exception is approved.
Action Required
By January 1, 2023: Billing team must stop processing Remicade authorizations for commercial members and switch to billing for Avsola or Inflectra (no authorization needed). For new Medicare members requesting Remicade after January 1, 2023, providers must complete coverage exception forms through Prime Therapeutics and document trial of Avsola or Inflectra first. Update encounter forms and EMR templates to reflect biosimilar preference.