Description: Injection, inflectra
Unit: 10 mg
Pay quarter: Q4 2023
Dosage and Frequency
Ulcerative Colitis (UC)
Ankylosing Spondylitis (AS)
Psoriatic Arthritis (PsA)
Plaque Psoriasis (Ps)
• 5mg/kg IV at 0, 2, and 6 weeks
• 5mg/kg IV every 8 weeks
• 3mg/kg IV at 0, 2, and 6 weeks
• 3mg/kg IV every 8 weeks
Calculate drug reimbursement
(ASP: $394.27, Margin: $23.66)
# Units to bill:30
Prior auth criteria for Inflectra may include but is not limited to:
1. A prescription from a licensed healthcare provider must be provided.
2. The prescription must be for an FDA-approved indication for Inflectra.
3. The patient must meet appropriate criteria for the indication.
4. The patient must meet the criteria of the payor’s policy.
5. The patient must have not responded adequately to other treatments.
6. The patient must be monitored to ensure safety and efficacy throughout the course of treatment.
7. The patient must have an appropriate response to drug therapy.
8. The treatment plan must be consistent with current clinical practice guidelines.
9. The patient must be compliant with the treatment plan.
10. The patient must have no contraindications to the drug.
Insurance prior auth guidelines:
Inflectra (PFIZER INC.)