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.
Important Safety Information & Indication
Indications
- Rituxan® (rituximab), in combination with methotrexate, is indicated for the treatment of adult patients with moderately to severely active rheumatoid arthritis (RA) who have had an inadequate response to one or more TNF antagonist therapies
- Rituxan® (rituximab), in combination with glucocorticoids, is indicated for the treatment of adult patients with Granulomatosis with Polyangiitis (GPA) and Microscopic Polyangiitis (MPA)
- Rituxan® (rituximab) is indicated for the treatment of adult patients with moderate to severe pemphigus vulgaris
BOXED WARNINGS and Additional Important Safety Information
BOXED WARNINGS
Infusion-Related Reactions: Rituxan administration can result in serious, including fatal infusion-related reactions. Deaths within 24 hours of Rituxan infusion have occurred. Approximately 80% of fatal infusion reactions occurred in association with the first infusion. Monitor patients closely. Discontinue Rituxan infusion for severe reactions and provide medical treatment for Grade 3 or 4 infusion-related reactions.
Severe Mucocutaneous Reactions: Severe, including fatal, mucocutaneous reactions can occur in patients receiving Rituxan.
Hepatitis B Virus (HBV) Reactivation: HBV reactivation can occur in patients treated with Rituxan, in some cases resulting in fulminant hepatitis, hepatic failure, and death. Screen all patients for HBV infection before treatment initiation, and monitor patients during and after treatment with Rituxan. Discontinue Rituxan and concomitant medications in the event of HBV reactivation.
Progressive Multifocal Leukoencephalopathy (PML), including fatal PML, can occur in patients receiving Rituxan.
Warnings and Precautions
Rituxan administration can also result in additional serious, including fatal, adverse reactions including:
- Tumor lysis syndrome (TLS): Administer aggressive intravenous hydration, anti-hyperuricemic agents, monitor renal function
- Infections: Withhold Rituxan and institute appropriate anti-infective therapy. Rituxan is not recommended for use in patients with severe, active infections
- Cardiovascular adverse reactions: Discontinue infusions in case of serious or life-threatening events
- Renal toxicity: Discontinue in patients with rising serum creatinine or oliguria
- Bowel obstruction and perforation: Consider and evaluate for abdominal pain, vomiting, or related symptoms
- Immunizations: Live virus vaccinations prior to or during Rituxan treatment are not recommended
- Embryo-Fetal toxicity: Can cause neonatal harm. Advise of potential risk to neonates and use of effective contraception
- Patients with RA should be closely observed for signs of infection if biologic agents and/or DMARDs other than methotrexate are used concomitantly
- The use of Rituxan in patients with RA who have not had prior inadequate response to one or more TNF antagonists is not recommended
- Use of concomitant immunosuppressants other than corticosteroids has not been studied in GPA, MPA, or PV patients exhibiting peripheral B-cell depletion following treatment with Rituxan
Most Common Adverse Reactions
Rheumatoid Arthritis (RA)
Most common adverse reactions (≥10%) were upper respiratory tract infection, nasopharyngitis, urinary tract infection, and bronchitis. Other important adverse reactions include infusion-related reactions, serious infections, and cardiovascular events.
Granulomatosis With Polyangiitis (GPA) (Wegener’s Granulomatosis) and Microscopic Polyangiitis (MPA)
Most common adverse reactions (≥15%) were infections, nausea, diarrhea, headache, muscle spasms, anemia, and peripheral edema. Other important adverse reactions include infusion-related reactions.
Pemphigus Vulgaris (PV)
Most common adverse reactions (≥15%) were infusion-related reactions and depression. Other important adverse reactions include infections.
You may report side effects to the FDA at (800) FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at (888) 835-2555.
For additional Important Safety Information, please see the Rituxan full Prescribing Information, including BOXED WARNINGS.