Rituximab (Rituxan, Ruxience, Truxima, Riabni)

Rituximab is covered only for non‑oncology FDA‑approved indications (moderately–severely active RA, GPA, MPA, pemphigus vulgaris) and specified off‑label compendial uses (ITP, MS, NMO spectrum disorder, SLE, GVHD) and is excluded for oncology and non‑compendial uses. Coverage requires indication‑specific prior therapy trials and documentation, specialist prescribing/consultation, limits on dosing/frequency (e.g., minimum 16‑week intervals for many indications, 6 months for ITP/MS), prohibition of concurrent biologic/targeted synthetic DMARD use for RA, and evidence of therapeutic response for reauthorization.

"Pemphigus vulgaris initial authorization: Therapy is initiated in combination with a corticosteroid, unless contraindicated; AND The rituximab product is prescribed by or in consultation with a der..."

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