Belimumab (Benlysta)

Belimumab (Benlysta) is covered only for FDA‑approved uses — active, autoantibody‑positive SLE and active lupus nephritis in patients ≥5 years (subcutaneous formulation restricted to ≥18) — and not for non‑FDA indications. Coverage requires documented autoantibody positivity (ANA and/or anti‑dsDNA), concurrent use of at least one standard therapy (or documented intolerance), prescription/consultation by an appropriate specialist (e.g., rheumatologist or nephrologist), initial approvals of 4 months (SLE) or 6 months (lupus nephritis), and documentation of clinical response for 12‑month reauthorization.

"Benlysta is indicated for the treatment of patients aged 5 years and older with active, autoantibody-positive, systemic lupus erythematosus (SLE) who are receiving standard therapy."

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