Rituximab (Riabni®, Rituxan®, Ruxience®, & Truxima®) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers IV rituximab products for specified non‑oncology autoimmune/immune‑mediated conditions (e.g., ITP, pemphigus vulgaris, RA, NMOSD, TTP, MS, IgG4‑RD, PTLD, AIHA, immunotherapy‑related encephalitis) when strict diagnosis‑specific criteria and documentation are met, but Rituxan Hycela is considered unproven for non‑oncology uses and several conditions (e.g., SLE, dermatomyositis, idiopathic membranous nephropathy, anti‑GM1 neuropathies) are listed as not medically necessary. Key requirements include preference for Truxima and Ruxience (non‑preferred products require documented intolerance/contraindication plus physician attestation), initial and renewal authorizations generally limited to ≤12 months, prescriber attestation that dosing follows FDA labeling or published evidence, documentation of positive clinical response for continuation, and prohibitions on specified concurrent therapies.

"Immune thrombocytopenic purpura (ITP) — treatment of ITP when all of the following are met: diagnosis of ITP; documented platelet count < 30 × 10^9/L; history of failure, contraindication, or intol..."