Renflexis — Blue Cross Blue Shield of Montana
moderately to severely active rheumatoid arthritis (RA)
Preferred products
- Avsola
- Inflectra
- Remicade
- Ixifi
- Renflexis
- Infliximab (unbranded) biosimilars
Initial criteria
- Requested agent is eligible for continuation of therapy AND the prescriber states the patient has been treated with the requested agent (starting on samples is not approvable) within the past 90 days AND is at risk if therapy is changed
- OR
- Patient has a diagnosis of moderately to severely active rheumatoid arthritis (RA) AND BOTH of the following:
- – Patient has tried and had an inadequate response to maximally tolerated therapy (criteria details continue beyond this excerpt)