Benlysta® (Belimumab) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers intravenous Benlysta (belimumab) for active systemic lupus erythematosus and active lupus nephritis (FDA‑approved, ≥5 years) under the medical benefit, excludes severe active CNS lupus and other unproven indications (e.g., ANCA‑associated vasculitis, rheumatoid arthritis, Sjögren’s, Waldenström) and generally directs self‑administered subcutaneous Benlysta to the pharmacy benefit (California exception noted). Coverage requires documentation of diagnosis and absence of severe CNS disease, concurrent non‑biologic standard therapy (e.g., antimalarials, corticosteroids, or immunosuppressants), no combination with other biologics or with Lupkynis/Saphnelo, FDA‑label dosing/titration, initial and renewal authorizations limited to ≤12 months, and continuation requires prior IV Benlysta exposure with documented clinical benefit.

"Benlysta is unproven and not medically necessary for: Rheumatoid arthritis."