Cigna Infliximab (Remicade & Biosimilars) prior authorization requirements (2026)
What Cigna generally requires to approve Infliximab (Remicade & Biosimilars) (CPT J1745, Q5103, Q5104, Q5121), for Commercial plans. Yes. Cigna generally requires prior authorization for Infliximab (Remicade & Biosimilars) (CPT J1745, Q5103, Q5104, Q5121).
Medical-necessity criteria Cigna generally applies
Prior authorization required; preferred infliximab IV products must be used before a non-preferred product. RHEUMATOID ARTHRITIS (prescribed by/with a rheumatologist): age over 18; tried one conventional synthetic DMARD (methotrexate, leflunomide, hydroxychloroquine, or sulfasalazine) for at least 3 months (waived if the patient already had a 3-month trial of a biologic). CROHN'S DISEASE / ULCERATIVE COLITIS (prescribed by/with a gastroenterologist): age 6 or older; current guidance favors upfront advanced therapy with no mandated conventional-therapy step. Initial approval 6 months; continuation 1 year with documented beneficial response (e.g., fecal calprotectin, CRP, endoscopy, reduced corticosteroid use, or symptom improvement). RA dosing up to 3 mg/kg at weeks 0, 2, 6 then no more frequently than every 8 weeks; established patients up to 10 mg/kg no more often than every 4 weeks.
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Infliximab (Remicade & Biosimilars). Confirm the covered diagnosis list against the current Cigna policy.
Commonly required documentation
- Diagnosis
- documented conventional-DMARD trial (RA)
- specialist prescriber
- response measures for continuation.
Situations to verify before submitting
Cigna may not cover Infliximab (Remicade & Biosimilars) in these situations. Verify against the current policy rather than assuming a denial:
- Should not be administered in combination with another biologic or a targeted synthetic oral small-molecule drug for an inflammatory condition (conventional synthetic DMARDs such as methotrexate, leflunomide, hydroxychloroquine, sulfasalazine may be combined)
How to submit
- Method: Cigna / Express Scripts prior authorization
- Portal: Cigna Provider (CHCP)
Source
Source: Cigna Coverage Policy IP0660 Infliximab Intravenous (eff 2026-03-15). TB screening is not stated as a discrete criterion in IP0660. Last verified 2026-06-17.
Frequently asked questions
Does Cigna require prior authorization for Infliximab (Remicade & Biosimilars)?
Yes. Cigna generally requires prior authorization for Infliximab (Remicade & Biosimilars) (CPT J1745, Q5103, Q5104, Q5121).
What does Cigna require to approve Infliximab (Remicade & Biosimilars)?
Prior authorization required; preferred infliximab IV products must be used before a non-preferred product. RHEUMATOID ARTHRITIS (prescribed by/with a rheumatologist): age over 18; tried one conventional synthetic DMARD (methotrexate, leflunomide, hydroxychloroquine, or sulfasalazine) for at least 3 months (waived if the patient already had a 3-month trial of a biologic). CROHN'S DISEASE / ULCERAT… Always confirm against the current Cigna policy.
How long does a Cigna prior authorization take?
Turnaround varies by plan and submission method. Check the Cigna portal for current timeframes.
Submitting Infliximab (Remicade & Biosimilars) to Cigna?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.