Rituximab (Rituxan)

This policy covers non‑oncology use of rituximab (Rituxan) for specified FDA‑approved indications (adult RA, GPA/MPA with glucocorticoids, moderate‑to‑severe pemphigus vulgaris) and compendial off‑label uses (ITP, MS, NMO, SLE, GVHD); oncology indications are excluded. Coverage requires indication‑specific prior therapy failures (e.g., ≥1 TNF antagonist or ≥3 months of a csDMARD for RA), prescribing by or consultation with an appropriate specialist, documentation of response or disease control where required, minimum intervals since prior rituximab courses (typically ≥16 weeks; ITP reauthorization ≥6 months), and adherence to dosing/frequency and approval‑duration limits.

"Non-oncology uses when the individual is diagnosed with an FDA-approved indication or an off-label compendial use and meets the specific coverage guidelines and applicable safety criteria for the c..."