Coverage changes for Remicade and biosimilars
November 2025| Harvard Pilgrim Health Care Commercial| Tufts Health Plan Commercial| Tufts Health Direct| Tufts Health One Care| Tufts Health Plan Senior Care Options| Tufts Medicare Preferred
In last month’s issue of Insights and Updates for Providers, we introduced upcoming coverage changes for Harvard Pilgrim Commercial, Tufts Health Plan Commercial, and Tufts Health Direct related to the monoclonal antibody medication Remicade (infliximab) and its biosimilars. We’d like to provide a reminder of these changes, as well as some updated information regarding product applicability.
Effective Jan. 1, 2026 for the above-referenced products, and additionally for Tufts Medicare Preferred, Tufts Health Plan Senior Care Options, and Tufts Health One Care, Avsola and Inflectra will be the preferred infliximab products. Remicade and unbranded Infliximab (HCPCS code J1745) will become non-preferred products.
As we indicated in last month’s article, members of our Commercial products and Tufts Health Direct currently utilizing Remicade or unbranded Infliximab will not need a new prior authorization request for Avsola or Inflectra in order to transition to one of these two preferred products. For our Senior Products (Tufts Medicare Preferred, Tufts Health Plan Senior Care Options, and Tufts Health One Care), the change will apply only to members initiating treatment of infliximab on or after Jan. 1, 2026.
Our Medical Benefit Drug MNGs for Targeted Immunomodulators – Skilled Administration and Medicare Part B Step Therapy, which you can find here, have been updated to reflect these changes.