Medicare Reimbursing for Inflectra, Pfizer's Infliximab Biosimilar

January 11, 2017
Jackie Syrop

Pfizer announced that the Centers for Medicare and Medicaid Services (CMS) will cover the cost of the company’s biosimilar Inflectra (infliximab-dyyb) for Medicare enrollees as a Part B-covered drug. Inflectra was approved by the FDA in April 2016 as a biosimilar to Janssen Biotech’s Remicade (infliximab) for reducing signs and symptoms in patients with rheumatoid arthritis, adult and pediatric Crohn’s disease, adult ulcerative colitis, ankylosing spondylitis, psoriatic arthritis, and chronic severe plaque psoriasis.

The CMS reimbursement price, which took effect January 1, 2017, is a 15% discount to the Wholesale Acquisition Cost (WAC) of Remicade. The WAC does not include discounts to payers, providers, distributors, and other purchasing organizations.

Inflectra is the first biosimilar monoclonal antibody, and the second biosimilar, to become available in the United States. The FDA’s approval of Inflectra as a biosimilar to Remicade did not include interchangeability with the reference drug; pharmacists cannot substitute Inflectra for Remicade without a physician’s instructions.

Pfizer announced the launch of the Pfizer enCompass program, a reimbursement service and patient support program offering coding and reimbursement support for providers, co-pay assistance to eligible patients who have commercial insurance that covers Inflectra, and financial assistance for eligible uninsured and underinsured patients.

Pfizer also announced the availability of pricing for 340B hospitals, a drug pricing program for eligible healthcare organizations that serve as safety net providers, including Medicare/Medicaid Disproportionate Share Hospitals, children’s hospitals, Ryan White clinics, and State AIDS Drug Assistance Programs.

Inflectra began shipping to wholesalers in late November 2016, and can now be ordered from wholesalers across the country.