Rituximab (Rituxan, Ruxience, Truxima, Riabni)

Rituximab is covered for non‑oncology FDA‑approved and compendial off‑label indications (RA, GPA, MPA, pemphigus vulgaris, ITP, MS, NMO, SLE, GVHD) and this policy does not cover oncology uses. Coverage requires documentation of the approved or compendial indication, specified prior therapy trials (e.g., 3‑month biologic or csDMARD trial for RA; prior therapies for ITP; DMT failure for MS), prescribing or consultation by the appropriate specialist, no concurrent biologic/targeted DMT use, adherence to dosing/maximums and minimum intervals between courses (commonly 16 weeks for RA/pemphigus/GPA/MPA and 6 months for ITP/MS/SLE), and clinical response/relapse documentation for reauthorization.

"Moderately to severely active rheumatoid arthritis (non-oncology indication)"

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