CareCost Prior authorization
Required
See what the payer requires before you schedule or buy the drug.
Prior authorization · preferred product · clinical criteria · dosing · site of care
30 payer policy sets · source-linked · reviewed August 2026
Aetna + Crohn’s disease is shown as a live example until you choose a payer.
1. Prior authorization
This payer requires an approval on file before Remicade is purchased or infused for this member.
Note : Requires Precertification: Precertification of an infliximab product is required of all Aetna participating providers and members in applicable plan designs.
2. Covered indication
Moderately to severely active Crohn's disease.
Crohn’s disease (CD) For treatment of moderately to severely active CD;
3. Covered dosing
Induction: 5 mg/kg IV at weeks 0, 2, 6
Maintenance: 5 mg/kg IV every 8 weeks
Crohn's disease, moderate-to-severe or fistulizing (adults) Induction: 5 mg/kg IV at weeks 0, 2, and 6 Maintenance: 5 mg/kg IV every 8 weeks For persons who respond and then lose their response, consideration may be given to treatment with 10 mg/kg IV every 8 weeks. Persons who do not respond by week 14 are unlikely to respond and consideration should be given to discontinue infliximab in these persons.
What opens in CareCost
Aetna · Remicade · Crohn’s disease
For every requirement: the exact payer criteria, the source citation, a check-off, and a save to the patient’s chart.
In CareCost: check off each requirement · save to the patient · print for the chart
Aetna · Remicade · Crohn’s disease
You have already checked the policy, indication and covered dose. Open the remaining requirements and work them as a patient checklist.
CareCost tracks Remicade coverage requirements across 30 payer policy sets.
Aetna · Anthem / Elevance · Cigna · UnitedHealthcare · Regence · Premera · Kaiser · BCBS plans + more
Coverage clearance is only the first step.
CareCost carries the same patient through the entire workflow.
Finish this patient’s estimate →25 of 30 commercial payers require prior authorization. Prior-treatment, preferred-product and site-of-care rules vary by plan.
25 require PA · 30 have clinical criteria · 17 restrict site of care · 20 prefer a biosimilar
Many commercial payers require approval before infliximab is purchased or infused.
Coverage depends on the diagnosis included in the payer’s infliximab policy.
Plans may require documentation of previous therapies, failures, contraindications or preferred alternatives.
Some plans prefer a biosimilar or require an exception before covering Remicade.
The ordered dose and frequency may need to match diagnosis-specific policy criteria.
Some plans restrict specialty-drug infusions to approved sites or settings.
Certain diagnoses may require treatment by, or consultation with, a particular specialist.
No prior authorization for Part B infliximab. Coverage follows the diagnosis codes in the Medicare policy.
It depends on the payer and plan. Many commercial payers require prior authorization or apply clinical coverage criteria before treatment. Check this patient’s payer →
Crohn’s disease is a covered indication under many infliximab policies, but payer-specific clinical, dosing, product and site-of-care requirements can still apply. Check coverage →
It depends on the payer. Some policies prefer another infliximab product or require an exception before Remicade is covered. Check preferred-product rules →
CareCost turns the applicable payer policy into a patient-level checklist showing each requirement, what to confirm, and the source language supporting it. Open patient clearance →
Policies verified August 2026 · page reviewed
Payer medical and specialty-drug policies · prior-authorization criteria · site-of-care policies · preferred-product policies. Every CareCost requirement links back to its source policy.