We made changes to coverage for infliximab biosimilar products for Medicare Advantage members

Blue Cross Blue Shield of Michigan removed authorization requirements for certain infliximab biosimilar drugs and designated preferred infliximab biosimilar drugs for Medicare Plus Blue^SM and BCN Advantage^SM members. This change started in April 2020.

Removing authorization requirements

For dates of service on or after April 3, 2020, we no longer require authorization for the following infliximab biosimilars for Remicade^® for Medicare Plus Blue and BCN Advantage members:

• Q5103 Inflectra^®
• Q5104 Renflexis^®

Designating preferred biosimilar drugs

Since April 20, 2020, we’ve designated the following drugs as preferred infliximab biosimilar products for Medicare Plus Blue and BCN Advantage members:

• J3590 Avsola^™
• Q5103 Inflectra
• Q5104 Renflexis

As part of our shared commitment to keeping health care affordable for all, we encourage you to switch members to one of the preferred infliximab biosimilar products.

Important: Remicade won’t be considered a preferred biosimilar and will continue to require authorization for Medicare Plus Blue and BCN Advantage members.

List of requirements

We’ve updated the Medical Drug and Step Therapy Prior Authorization List for Medicare Plus Blue PPO and BCN Advantage members with these changes.

The specialty medications on this list can be administered in outpatient sites of care, a physician’s office, an outpatient facility or a member’s home.