Infliximab and Associated Biosimilars

This policy covers coverage of infliximab and its biosimilars for medically necessary, FDA‑labeled non‑oncologic indications (primarily autoimmune disorders) and for continuation therapy in patients demonstrating benefit, across specified commercial, individual, and New Mexico Medicaid plans. Initial therapy is limited to preferred products (Avsola, Inflectra, unbranded infliximab, Remicade); coverage of non‑preferred biosimilars (e.g., Renflexis, Ixifi) requires failure, intolerance, or contraindication to at least two preferred agents, dosing/frequency/duration must match FDA labeling or recognized compendia/guidelines, off‑label uses require compendium support or two peer‑reviewed articles, and oncologic indications are excluded.

"Drug therapy requests that are proven effective for the relevant diagnosis or procedure."

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