Belimumab (Benlysta)

Benlysta (belimumab) is covered only for FDA‑approved uses — active, autoantibody‑positive SLE in patients ≥5 years and active lupus nephritis in patients ≥18 years — and is not supported for non‑FDA indications or if coverage criteria are not met. Coverage requires lab evidence of autoantibody positivity (ANA and/or anti‑dsDNA), concurrent standard therapy (or documented intolerance), prescribing/consultation by an appropriate specialist, adherence to specified IV/SC dosing and age limits, initial approvals (SLE 4 months, LN 6 months) with 12‑month renewals contingent on documented clinical response (e.g., fewer flares, steroid reduction, improved serologies or organ/clinical function).

"Active, autoantibody-positive, systemic lupus erythematosus (SLE) in patients aged 5 years and older who are receiving standard therapy."

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