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Infliximab (unbranded) — Blue Cross Blue Shield of Texas

moderately to severely active rheumatoid arthritis (RA)

Preferred products

  • Avsola
  • Inflectra
  • Remicade
  • Renflexis

Initial criteria

  • ONE of the following: (A) The requested agent is eligible for continuation of therapy AND the following: 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 (B) ONE of the following: (1) BOTH of the following: (A) ONE of the following: (1) The patient has a diagnosis of moderately to severely active rheumatoid arthritis (RA) AND BOTH of the following: (A) ONE of the following: (1) The patient has ONE of the following: (A) Has tried and had an inadequate response to maximally tolerated dose DMARD therapy