Effective February 15, 2022, the following drugs will be designated preferred infliximab products for members enrolled in AmeriHealth plans:

• Remicade^® (infliximab)
• Unbranded Johnson & Johnson infliximab
• Inflectra^® (infliximab-dyyb)

How will this affect my patients?

AmeriHealth selected Remicade as a preferred product to maintain continuity of care for our members with chronic conditions who wish to remain on the reference product. By adding two other preferred infliximab products, we are giving providers a wider selection of treatment options. 

New coverage requests for infliximab for members will only be approved for the three preferred products, in accordance with our medical policy.

Members who are currently approved to receive a nonpreferred infliximab product (e.g., Avsola^®, Ixifi^®, Renflexis^®) can continue their regimen. They will not be required to transition to a preferred product. However, if the provider and member want to switch to a preferred product, they may do so.

Why are these changes happening?

AmeriHealth is constantly evaluating best practice standards and industry trends to help manage specialty drug costs. Remicade is a highly used biologic that is a significant contributor to specialty drug spend. The U.S. Food and Drug Administration (FDA) has approved several biosimilars for Remicade. According to the FDA, biosimilars have no clinically meaningful difference from FDA-approved reference products in terms of safety and effectiveness.*

Designating preferred products allows AmeriHealth to take advantage of the growing availability of biosimilars, as well as the competition between biosimilars and reference products. This competition may reduce costs and expand members' access to more affordable therapies.

Policy updates

The AmeriHealth medical policy for infliximab will be updated to reflect the new coverage criteria for preferred products. Medical policy #08.00.34q: Infliximab and Related Biosimilars will be posted as a Notification on January 14, 2022, and will go into effect February 15, 2022.

To view the Notification for this policy, please visit our Medical and Claim Payment Policy Portal.

*U.S. Food & Drug Administration. “Biosimilar and Interchangeable Products." 2017. Available from: https://www.fda.gov/drugs/biosimilars/biosimilar-and-interchangeable-products​