Infliximab (Remicade) and Medicare

The short answer

Infliximab is given as an infusion. So it is covered by Part B. You pay 20% of the cost. There is no yearly limit on that 20% unless you have a Medicare supplement policy or an Advantage plan.

At the usual rheumatoid arthritis dose, that comes to roughly $1,200 to $1,450 a year for a mid-sized adult. That is less than most biologics. Infliximab is given every eight weeks, not every month. A higher dose or more frequent infusions raise the cost. There is no limit on how high it can go.

There is no version you can take at home. A version of infliximab called Zymfentra is given as a shot under the skin. But it is approved only for Crohn’s disease and ulcerative colitis. It is not approved for any rheumatology condition. So unlike some other biologics, there is no Part D route for you. The $2,100 cap is not available to you.

The biosimilar switch, and what it really saves you

There are four infliximab products on the US market. Remicade is the original. The other three are biosimilars: Inflectra, Renflexis and Avsola. A biosimilar is the same medicine made by a different company. The FDA approves it on the same standard of evidence.

You will read that biosimilars are much cheaper. For infliximab under Medicare in 2026, that is not true. Here is what Medicare pays per 10 mg:

Best case, switching to the cheapest biosimilar saves you about $190 a year. That is not nothing. But it is not what the word “biosimilar” suggests. Compare rituximab. There, the cheapest version costs a quarter of the original.

The saving is small, but plans still push the switch hard. That is because the plan’s saving is not the same as yours. Your share is 20%. The plan pays the other 80%. Across thousands of members, that 16% adds up to real money for the plan.

Your plan can make you switch. It can also make you switch again.

Under Original Medicare, nobody can make you switch products. Nobody has to approve the infusion in advance. Your rheumatologist decides.

Medicare Advantage plans are allowed to require it, and the large ones do. One national insurer’s 2026 policy requires at least 14 weeks on a biosimilar first. It pays for Remicade only if the biosimilar gave little response. Another insurer lists Remicade as non-preferred outright. And nothing in the rules stops a plan from preferring a different product next year. It could prefer a third one the year after.

The American College of Rheumatology has taken a position on this: “The ACR opposes insurer-mandated switching to biosimilars and is concerned over frequent non-medical switching… which may harm patients and lead to disease relapse.”

What the evidence says about switching

Two things are separate here. One is whether the medicine works the same. The other is whether people do well when they are switched.

• The medicine works the same. The NOR-SWITCH trial randomised 482 patients. It found no meaningful difference between the original and the biosimilar.
• But switching itself can go badly. In one real-world study, 24% of patients stopped the biosimilar within six months. Most stopped because of symptoms they felt. Their blood markers and disease scores did not change. This is called the nocebo effect. Expecting a worse result makes people feel worse.
• How it is explained matters a great deal. The same switch was also done with a structured explanation from the clinical team. Then the drop-out rate fell from 24% to 6.6%.

Practical version: if your plan makes you change products, that is not a reason to panic. It is a very good reason to ask your rheumatology team to walk you through it. Ask before the first infusion.

The stocking mismatch

The practice buys infusion medications first and bills for them afterwards. So the infusion center keeps a stock of one or two infliximab products.

Your plan may prefer a product your infusion center does not stock. Then somebody has to fix it. The center may order it in. Your doctor may file an exception. Or you may move to a different infusion site. None of that is your fault. All of it takes time. It is the most common reason an infusion gets pushed back.

Ask before January: which infliximab product does my plan prefer next year, and does my infusion center carry it?

Other things to know

• The infusion visit is billed separately. You pay 20% of the drug. You also pay 20% of the charge for the infusion itself.
• Where you get infused changes the price. A hospital outpatient department adds a facility fee. That is a second bill from the hospital for the room. A doctor’s office or an independent infusion suite usually costs you less. The medication is exactly the same.
• The Remicade copay card does not work if you have Medicare. Federal law prohibits it. Two routes do work. One is an independent charitable foundation. The other is the manufacturer’s income-based assistance program.
• None of these products is legally “interchangeable.” A pharmacy cannot swap one for another on its own. Your doctor has to write for the specific one. That is a protection. It is also why switching creates paperwork.
• Dose increases raise your 20%. Going from 3 mg/kg every 8 weeks to 5 mg/kg every 6 weeks roughly doubles what you pay. That comes to around $2,100–$2,500 a year.

Free help, from someone who is not paid a commission

• Washington: SHIBA — insurance.wa.gov/shiba or 1-800-562-6900
• Any other state: SHIP — shiphelp.org
• Compare plans — medicare.gov/plan-compare
• Extra Help — ssa.gov/medicare/part-d-extra-help

Why isn’t my infusion covered by the $2,100 cap?

Because the $2,100 cap only applies to Part D. An infusion is paid by Part B. The cap Congress created covers drugs you pick up and take yourself. A medication a nurse or doctor gives you is paid under Part B instead. There you owe 20% of the cost every time. And there is no annual ceiling at all.

It is the same Medicare. It is often the same drug. It is often the same disease. The rulebook is chosen by who puts the medicine in you. The cap and the Part B coinsurance, your 20% share, are two separate rules. News about one does not change the other.

A worked example. If Medicare’s approved amount for a year of your infusions is $18,000, you owe about $3,600. That is true this year, next year, and every year you stay on it. The $2,100 cap does not apply to any of it.

Four things do put a ceiling on Part B costs:

• A Medicare supplement (Medigap) policy, which pays the 20% for you. This is the main one. The window to buy one closes six months after you enroll in Part B in most states.
• A Medicare Advantage plan’s yearly out-of-pocket maximum. That is the most you pay in a year. It applies to everything the plan covers. But it comes with prior authorization attached. That means the plan must approve the drug before you can get it.
• QMB, a Medicare Savings Program that eliminates the 20% entirely. QMB and Extra Help are different programs. Extra Help applies to Part D drugs only. It does nothing for a Part B drug.
• Full Medicaid, or retiree coverage that pays after Medicare.

Related

• Medicare and your medication
• Why your medication needs permission first — how prior authorization works and what to do when it goes wrong
• Rituximab and Medicare — where the biosimilar saving is large
• Rheumatoid arthritis guide
• Where you get infused changes the bill — the same infusion costs more at a hospital, and the drug bill Medicare does not cover

Where these figures come from

1. Medicare payment limits per 10 mg, CMS Part B ASP pricing file effective July 1 – September 30, 2026: infliximab (J1745) $31.479; Avsola (Q5121) $30.830; Inflectra (Q5103) $27.710; Renflexis (Q5104) $26.615.
2. Remicade prescribing information — FDA. Rheumatoid arthritis: 3 mg/kg at weeks 0, 2 and 6, then every 8 weeks, with methotrexate; may be increased to 10 mg/kg or given as often as every 4 weeks. Ankylosing spondylitis 5 mg/kg every 6 weeks; psoriatic arthritis 5 mg/kg every 8 weeks. Supplied in 100 mg vials.
3. Annual figures assume a 70 kg adult at 3 mg/kg every 8 weeks (6.5 infusions, 300 mg billed per infusion), plus the infusion administration charge at CY2026 physician fee schedule rates. Your weight, dose and interval change the number.
4. Part B annual deductible $283 and 20% coinsurance with no annual limit for 2026 — CMS, “2026 Medicare Parts A & B Premiums and Deductibles”; Social Security Act §1833(a).
5. Approved infliximab products and interchangeability status — FDA Purple Book, July 2026. Zymfentra (subcutaneous infliximab) is approved for maintenance of ulcerative colitis and Crohn’s disease in adults only; it carries no rheumatology indication.
6. Step therapy permitted for Medicare Advantage Part B drugs and not in Original Medicare — 42 CFR §422.136. The 14-week biosimilar trial requirement and the non-preferred listing are taken from two national insurers’ published 2026 Part B step therapy and preferred drug lists.
7. No prior authorization program in Original Medicare covers physician-administered drugs — CMS, Prior Authorization and Pre-Claim Review Initiatives.
8. American College of Rheumatology Position Statement on Biosimilars, August 2024.
9. NOR-SWITCH: Jørgensen et al., The Lancet 2017;389:2304–16 (n=482, non-inferiority confirmed). Nocebo discontinuation: Tweehuysen et al., Arthritis & Rheumatology 2018;70:60–68 (24% discontinued at 6 months with unchanged objective measures). Improved outcome with structured communication: Petit et al., RMD Open 2021;7:e001396 (6.6% at 12 months).
10. Medicare Part B spending 2024: reference infliximab $367 million across 36,967 beneficiaries; biosimilars a further $97 million across roughly 16,600 beneficiaries — CMS Medicare Part B drug spending dashboard.
11. Copay assistance is prohibited for federal healthcare program beneficiaries — federal Anti-Kickback Statute, 42 U.S.C. §1320a-7b; Janssen Remicade savings program terms.

About this page

Written and reviewed by Alison Bays, MD, MPH, board-certified rheumatologist. Figures are current for 2026 and were last checked in August 2026.

This is educational information, not advice — not medical, legal, financial or insurance advice, and not a substitute for talking to your doctor or your plan. Nothing is sold here. No insurance is sold here, no plan is recommended, and neither this page nor its author is paid by any insurance company, plan, pharmaceutical manufacturer or broker. This page is not affiliated with, endorsed by, or connected to Medicare, the Centers for Medicare & Medicaid Services, or any government agency.

Found something wrong? Please tell us.