Remicade

Covered Uses:	All FDA-approved indications not otherwise excluded from Part D. Additional coverage for off-label use is provided for moderate to severe Hidradenitis suppurativa.
Exclusion:	Coverage is not provided for use of Remicade in combination with other biologics e.g., Enbrel, Kineret or Humira, etc.
Required Medical Information:	Coverage is provided in situations where the patient has been evaluated and screened for the presence of latent TB infection prior to initiating treatment with Remicade.
Age Restrictions:
Prescriber Restrictions:
Coverage Duration:	12 months
Other Criteria:	Coverage is provided for mild ulcerative colitis when the patient has had an inadequate response to at least one conventional treatment (for example: sulfasalazine, olsalazine, mesalamine, etc.), and for ankylosing spondylitis when the patient has experienced inadequate symptom relief from at least one other treatment such as NSAIDs, COX2 inhibitors, or methotrexate, unless the patient is unable to receive treatment with these drugs. Coverage is provided for Hidradenitis suppurativa when the patient has experienced inadequate symptom relief from two other conventional treatments such as antibiotics, anti-androgen and glucocorticoids, unless the patient is unable to receive treatment with these drugs or if the patient has severe disease.

Last Modified on 12/19/2012