Remicade Rheumatoid Arthritis Guidelines 1. Patient must have a diagnosis of rheumatoid arthritis. Patient must be on methotrexate therapy. A request for a higher dosage or an increase in administration frequency requires additional predetermination. Documentation of medical necessity should include radiological data, patient notes, medical literature, etc.
Coverage is based on medical necessity.
Retreatment is covered when a positive response from the initial treatment is noted. Retreatment is usually every eight weeks to maintain remission. Remicade for Crohn's disease requires precertification. An initial prior authorization request must be submitted before the medication is administered. If medical necessity is determined, approval on the initial prior authorization is active for a two-month period for the treatment of Crohn's disease.