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, and 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 works out to roughly $1,200 to $1,450 a year for a mid-sized adult — less than most biologics, because infliximab is dosed every eight weeks rather than monthly. Go up in dose or frequency and it climbs; there is nothing stopping it.

There is no version you can take at home. A subcutaneous infliximab called Zymfentra exists, but it is approved only for Crohn’s disease and ulcerative colitis, not for any rheumatology condition. So unlike some other biologics, there is no Part D route and no $2,100 cap available to you.

The biosimilar switch, and what it really saves you

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

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

Best case, switching to the cheapest biosimilar saves you about $190 a year. Not nothing, but not what the word “biosimilar” suggests. Compare rituximab, where the cheapest version costs a quarter of the original.

Which raises the obvious question: if the saving is small, why do plans push it so hard? Because the plan’s saving is not the same as yours. Your share is 20%; the plan pays the other 80%, and across thousands of members that 16% adds up to real money for them.

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

Under Original Medicare, nobody can make you switch products and 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 with minimal response before it will pay for Remicade. Another lists Remicade as non-preferred outright. And nothing in the rules stops a plan from preferring a different product next year, and 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

It is worth separating two things: whether the medicine works the same, and whether people do well when they are switched.

• The medicine works the same. The NOR-SWITCH trial randomised 482 patients and 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 — mostly for subjective symptoms, with no change in their blood markers or disease scores. This is called the nocebo effect: expecting a worse result makes people feel worse.
• How it is explained matters enormously. When the same switch was done with structured explanation from the clinical team, 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, and it is a very good reason to ask your rheumatology team to walk you through it properly before the first infusion.

The problem nobody sees coming: the stocking mismatch

Infusion medications are bought by the practice and billed afterwards. So the infusion center keeps a stock of one or two infliximab products.

If your plan prefers a product your infusion center does not stock, somebody has to fix it — the center orders it in, your doctor files an exception, or you move to a different infusion site. None of that is your fault, all of it takes time, and it is the most common reason an infusion gets pushed back.

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

Things that surprise people

• The infusion visit is billed separately. On top of 20% of the drug, you pay 20% of the charge for the infusion itself.
• Where you get infused changes the price. A hospital outpatient department adds a facility fee. A doctor’s office or an independent infusion suite usually costs you less for exactly the same medication.
• The Remicade copay card does not work if you have Medicare. Federal law prohibits it. Independent charitable foundations and the manufacturer’s income-based assistance program are the routes that do work.
• 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, and 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, 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, and 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, where you owe 20% of the cost every time and there is no annual ceiling at all.

It is the same Medicare, often the same drug, and frequently the same disease. The rulebook is chosen by who puts the medicine in you. Almost everything written about the cap leaves this out, so people on infusions read that their costs are now limited, and then the bills keep coming.

A worked example. If Medicare’s approved amount for a year of your infusions is $18,000, you owe about $3,600 — 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, and 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, which applies to everything the plan covers — though it comes with prior authorization attached.
• QMB, a Medicare Savings Program that eliminates the 20% entirely. This is the one people are not told about — and note that Extra Help, which people are told about, 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 genuinely large
• Rheumatoid arthritis guide
• Where you get infused changes the bill — the same infusion costs more at a hospital, and the bill nobody warns you about

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.

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