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.