Therefore, Aetna considers Avsola (infliximab-axxq), Remicade (infliximab), and Renflexis (infliximab-abda) to be medically necessary only for members who have a contraindication, intolerance or ineffective response to the available equivalent alternative targeted immune modulator, Inflectra (infliximab-dyyb). There is a lack of reliable evidence that Avsola (infliximab-axxq), Remicade (infliximab), and Renflexis (infliximab-abda) are superior to the lower cost targeted immune modulator, Inflectra (infliximab-dyyb), for moderate to severe plaque psoriasis. Avsola (infliximab-axxq), Remicade (infliximab), and Renflexis (infliximab-abda) are more costly to Aetna than other targeted immune modulator for moderate to severe plaque psoriasis. Moderate to Severe Plaque PsoriasisĪs defined in Aetna commercial policies, health care services are not medically necessary when they are more costly than alternative services that are at least as likely to produce equivalent therapeutic or diagnostic results. For all other indications, this policy applies to members who are new to treatment with a targeted immune modulator for the first time. For Avsola, Remicade, and Renflexis, this policy applies to all members requesting treatment with the targeted infliximab product. Note: For plaque psoriasis, this policy applies to all members requesting treatment with a targeted immune modulator. Brand Selection for Medically Necessary Indications
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