Description: Infliximab not biosimil 10mg
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: $923.69, Margin: $55.42)
# Units to bill:30
Prior auth criteria for Remicade may include but is not limited to:
1. The patient must have been diagnosed with an appropriate condition that requires treatment with Remicade.
2. The patient must have failed an adequate trial of conventional therapy.
3. The patient must have documentation of their medical history, including lab results and any other pertinent information.
4. The patient must not have any contraindications for use of Remicade.
5. The patient must have documentation of a recent physical exam, including height, weight, and vital signs.
6. The patient must have a current laboratory test result indicating an appropriate response to the medication.
7. The patient must have a signed treatment agreement from their physician.
8. The patient must have a signed informed consent from their physician.
Insurance prior auth guidelines:
Remicade (JANSSEN BIOTECH, INC.)
INFLIXIMAB (JANSSEN BIOTECH, INC.)