Rituximab and Biosimilars for Non-Oncologic Indications

Covers rituximab (Rituxan) and listed biosimilars for non‑oncologic indications, including autoimmune, inflammatory, and immune‑mediated disorders (e.g., autoimmune hemolytic anemia, GPA/MPA, chronic graft‑versus‑host disease, idiopathic membranous nephropathy, cryoglobulinemic vasculitis, and severe autoimmune blistering diseases). Coverage is limited to uses supported by FDA labeling or nationally recognized authoritative references (off‑label uses require compendia support or two peer‑reviewed articles), dosing must follow an authoritative source, continuation requires demonstrated clinical benefit, prior failure/intolerance to preferred agents is required for non‑preferred drugs, and final coverage is subject to the member’s benefit plan (applies to HCSC members in Ohio; oncologic uses are managed under a separate policy).

"Requested therapy must be proven effective for the relevant diagnosis or procedure based on current peer‑reviewed scientific literature or authoritative sources."