Inflectra to be preferred infliximab product for adult commercial PPO members, beginning Nov. 1

Starting Nov. 1, 2019, Inflectra^® (infliximab-dyyb and HCPCS code Q5103) will be the preferred infliximab product for adult Blue Cross Blue Shield of Michigan commercial PPO members.

Action required

As of Nov. 1, 2019, adult PPO members with an active authorization for an infliximab product other than Inflectra must transition to Inflectra.

The infliximab products other than Inflectra are:

• Remicade^® (infliximab) — HCPCS code J1745
• Renflexis^® (infliximab-abda) — HCPCS code Q5104

This change doesn’t apply to:

• Pediatric members age 15 or younger
• Pediatric members age 18 or younger and weighing 50 kg or less
• Any member covered by Medicare Plus Blue^SM PPO, BCN Advantage^SM or a Federal Employee Program^® Service Benefit Plan.

Note: This change took effect for BCN HMO^SM commercial members on May 1, 2019.

The authorization requirements apply only to groups currently participating in the standard commercial Medical Drug Prior Authorization Program for drugs administered under the medical benefit. Refer to the opt-out list for PPO groups that don’t require members to participate in the programs. To access the list, follow these steps:

1. Log in to Provider Secured Services.
2. Click on BCBSM Provider Publications and Resources.
3. Click on Newsletters & Resources.
4. Click on Forms.
5. Click on Physician administered medications on the right.
6. Click on BCBSM Medical Drug Prior Authorization Program list of groups that have opted out.

To access the medical policy on Inflectra:

1. Use the Medical Policies search tool.
2. Type "Inflectra" in the Policy/Topic Keyword field (not necessary to select a category).
3. Click Search.
4. Click the PDF, MEDICAL POLICY — INFLIXIMAB: REMICADE (J1745), RENFLEXIS (Q5104), INFLECTRA (Q5103).

On Nov. 1, the updated requirements for Inflectra will appear in the Blue Cross and BCN utilization management medical drug list.