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July 31, 2019

United Healthcare: Medical benefit coverage changes for preferred infliximab products

United Healthcare Commercial (UHC) has changed its drug policy for infliximab products used to treat Crohn’s disease and ulcerative colitis.

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Effective Oct. 1, 2019, UHC will no longer require the use of Remicade prior to coverage for Inflectra. As part of the notification/prior authorization review, UHC will require documentation to support the clinical requirement that members must try both Inflectra and Remicade, experience an adverse reaction, or have a contradiction to Inflectra and Remicade to receive coverage approval for Renflexis. 

Notification/prior authorization for Remicade is required when administered in an outpatient hospital setting. Notification/prior authorization for Inflectra is required when administered in an outpatient hospital, office or home setting.

See the July 2019 United Network Bulletin for more information. 

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