Updates on Existing Criteria
November 2026. The following changes to criteria are effective by November 30, 2026:
Prior Authorization Criteria – Clinical Updates
- Infusion Services Site of Care Criteria – the following are added to the list of affected medications:
- J1745 Remicade (infliximab)
- J1748 Zymfentra (infliximab-dyyb)
- Q5103 Inflectra (infliximab-dyyb)
- Q5104 Renflexis (infliximab-abda)
- Q5109 Ixifi (infliximab-qbtx)
- Q5121 Avsola (infliximab-axxq)
See the PacificSource Drug Lists page for the current drug list.