Infliximab (Avsola®, Inflectra®, Remicade®, & Renflexis®) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers FDA‑labeled infliximab products (Remicade and biosimilars Avsola, Inflectra, Renflexis) for indicated conditions such as Crohn’s disease, ulcerative colitis, RA (with methotrexate), plaque psoriasis, psoriatic arthritis, ankylosing spondylitis and certain pediatric indications, and lists hidradenitis suppurativa, juvenile idiopathic arthritis, myelodysplastic syndromes, Reiter’s, Sjögren’s, Still’s disease, undifferentiated spondyloarthropathy, and Wegener’s as not medically necessary. Key requirements include preferential use of Inflectra or Avsola (non‑preferred agents require a ≥14‑week trial of preferred biosimilars or documented intolerance plus physician attestation), documentation of diagnosis and prior therapy failures, prescriber specialty/consultation as specified, no concomitant targeted immunomodulators, dosing per FDA or policy limits, and authorizations typically ≤12 months (≤4 doses for acute GVHD/ICI toxicities), subject to member plan and LCD/LCA rules.