Rituximab (Rituxan®, Ruxience®, Truxima®, Riabni™)

Rituximab is covered for specified non‑oncology FDA‑approved indications (moderately‑to‑severely active RA, GPA, MPA, pemphigus vulgaris) and select off‑label compendial uses (ITP, MS, NMO spectrum disorder, SLE, GVHD); oncology uses are not addressed. Coverage requires indication‑specific prior therapy trials (e.g., RA: 3‑month trial of a biologic or a conventional synthetic DMARD; MS: failure/intolerance to ≥2 DMTs; ITP: trial of ≥1 therapy), appropriate specialty prescriber/consultation, no concurrent use with prohibited biologics/DMARDs or MS DMTs, minimum intervals between courses (commonly ≥16 weeks or 6 months), and documentation of clinical or objective improvement for reauthorization.

"Moderately to severely active rheumatoid arthritis"

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