Rituxan Coverage

Benefits Investigations

Genentech Rheumatology Access Solutions can conduct a benefits investigation (BI) to help you determine if Rituxan is covered, if prior authorizations (PAs) are required, which specialty pharmacy (SP) the health insurance plan prefers and if patient assistance might be needed.

Potential outcomes of a BI:

  • Treatment is covered
  • PA is required
  • Treatment is denied

A BI may be initiated once the SMN and PAN are submitted to Genentech Rheumatology Access Solutions.

These can be downloaded from Forms and Documents or submitted online via My Patient Solutions.

The completion and submission of coverage- or reimbursement-related documentation are the responsibility of the patient and health care provider. Genentech and Biogen make no representation or guarantee concerning coverage or reimbursement for any service or item.

Prior Authorization

Genentech Rheumatology Access Solutions can help you identify if a prior authorization (PA) is necessary and offer resources as you obtain it for your patient. PA support may be provided once the SMN and PAN are submitted to Genentech Rheumatology Access Solutions.

If your patient’s request for a PA is not granted, your Immunology Field Reimbursement Manager (IFRM) or Genentech Rheumatology Access Solutions Specialist can work with you to determine your next steps. You can find more tips like this in Forms and Documents.

The completion and submission of coverage- or reimbursement-related documentation are the responsibility of the patient and health care provider. Genentech and Biogen make no representation or guarantee concerning coverage or reimbursement for any service or item.

RSVP for Rituxan for Rheumatoid Arthritis

RSVP is a streamlined benefits reverification process for Rituxan for RA patients enrolled in Genentech Rheumatology Access Solutions. The service:

  • Tracks benefits investigation (BI) records
  • Reminds you when BIs are due
  • Facilitates better subsequent benefits verification, ensuring continued coverage is not delayed

To enroll, download the RSVP enrollment form in Forms and Documents.

PAN=Patient Authorization and Notice of Request for Transmission of Health Information to Genentech Access Solutions and Genentech® Access to Care Foundation.

SMN=Statement of Medical Necessity.