Payer PolicyActive
Briumvi® (Ublituximab-Xiiy) – Commercial Medical Benefit Drug Policyopen_in_new
UHC-POL-briumvi
UnitedHealthcare
Effective: October 1, 2025
Updated: December 6, 2025
created · Nov 30, 2025
Policy Summary
UnitedHealthcare covers Briumvi (ublituximab‑xiiy) for adults with relapsing forms of multiple sclerosis when dosed per FDA labeling and not given concomitantly with listed disease‑modifying, B‑cell‑targeted, or lymphocyte‑trafficking therapies; authorizations are limited to 12 months. Initial approval requires documented diagnosis and FDA‑consistent dosing, and continuation requires prior Briumvi use with documentation of a positive clinical response and ongoing absence of excluded concomitant therapies.
Coverage Criteria Preview
Key requirements from the full policy
"Briumvi (ublituximab-xiiy) is proven for the treatment of relapsing forms of multiple sclerosis (MS)."
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