Belimumab

This policy covers intravenous belimumab (Benlysta) as adjunctive therapy for active, autoantibody‑positive systemic lupus erythematosus (SLE) and for active lupus nephritis in patients aged ≥5 years, including pediatric patients 5–17, when given with standard lupus therapies. Coverage is limited to indications, dosing, and duration consistent with FDA labeling or recognized compendia/guidelines (or supported by required peer‑reviewed literature), excludes self‑administered subcutaneous belimumab (pharmacy benefit), use in children <5, combination with other biologics, and is subject to the member’s benefit plan and applicable state rules.

"Therapies are covered only when proven effective for the relevant diagnosis or procedure based on accepted standards of practice."

Sign up to see full coverage criteria, indications, and limitations.