Avsola and Inflectra will be preferred infliximab products, starting April 1

Starting April 1, 2022, the following drugs will be designated as preferred or nonpreferred infliximab products for Blue Cross Blue Shield of Michigan commercial, Medicare Plus Blue℠, Blue Care Network commercial and BCN Advantage℠ members:

• Preferred products
• Avsola^® (infliximab-axxq), HCPCS code Q5121
• Inflectra^® (infliximab-dyyb), HCPCS code Q5103

• Nonpreferred products
• Remicade^® (infliximab), HCPCS code J1745
• Renflexis^® (infliximab-abda), HCPCS code Q5104

Because the change in preferred drugs isn’t retroactive, existing authorizations aren’t affected. For courses of treatment that start on or before March 31, 2022, current prior authorization requirements continue to apply for all members, and site-of-care requirements continue to apply for commercial members.

Here’s what you need to know when prescribing these products

• For Blue Cross commercial and BCN commercial members: The products listed above currently require prior authorization. They’ll continue to require prior authorization when the preferred product changes go into effect April 1. Submit prior authorization requests through the NovoLogix^® online tool.
• For Medicare Advantage members (Medicare Plus Blue and BCN Advantage): For courses of treatment that start on or after April 1, prescribe preferred products when possible. These products don’t require prior authorization.
• If a member must receive a nonpreferred product, prior authorization is required. Submit the request through NovoLogix. The prior authorization requirement applies to both Renflexis and Remicade.

Submitting requests for prior authorization

Submit prior authorization requests through the NovoLogix^® online tool, which offers real-time status checks and immediate approvals for certain medications. If you have access to Provider Secured Services, you already have access to enter authorization requests through NovoLogix. If you need to request access to Provider Secured Services, complete the Provider Secured Access Application form and fax it to the number on the form.

Some Blue Cross commercial groups not subject to these requirements

• For Blue Cross commercial groups, this authorization requirement applies only to groups that currently participate in the standard commercial Medical Drug Prior Authorization Program for drugs administered under the medical benefit. To determine whether a group participates in the prior authorization program, see the Specialty Pharmacy Prior Authorization Master Opt-in/out Group list.
• To determine whether this change affects Blue Cross and Blue Shield Federal Employee Program^® members and UAW Retiree Medical Benefits Trust (non-Medicare) members, refer to the group-specific drug lists on the Blue Cross Medical Benefit Drugs page on our ereferrals.bcbsm.com website.

Lists of requirements

For full lists of requirements related to drugs covered under the medical benefit, see the following:

• Blue Cross and BCN utilization management medical drug list for Blue Cross commercial and BCN commercial members
• Medical Drug and Step Therapy Prior Authorization List for Medicare Plus Blue PPO and BCN Advantage members

We’ll update these lists to reflect this change before April 1.