Rituxan® (rituximab) Coverage

Benefits Investigation

Why is a benefits investigation important?

Genentech Rheumatology Access Solutions conducts a benefits investigation (BI) to help you better understand your patient's health insurance plan coverage for the costs associated with treatment. The BI can also determine if a prior authorization (PA) or patient assistance might be needed.

There are 3 possible outcomes of a BI:

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

To begin with Genentech Rheumatology Access Solutions, you must complete and submit a Statement of Medical Necessity (SMN) form and have your patient complete and submit a Patient Authorization and Notice of Release of Information (PAN) form. To request a BI, be sure to check the appropriate box on the SMN.

There are 3 possible outcomes of a BI:

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

The SMN can be submitted online via My Patient Solutions™ or downloaded from Forms and Documents.

Patients can access the PAN through Forms and Documents or submit the PAN online here.

This description of a BI is for informational purposes only. Genentech Rheumatology Access Solutions makes no representation or guarantee concerning reimbursement or coverage for any service or item.

Prior Authorization

Genentech Rheumatology Access Solutions can help your practice identify if a prior authorization (PA) is needed and offer support as you obtain it for your patient. All we need to begin are a completed and signed Statement of Medical Necessity (SMN) form requesting our assistance with the PA as well as a signed and dated Patient Authorization and Notice of Release of Information (PAN) form.

Genentech Rheumatology Access Solutions can help you as you submit the required PA forms and documentation. If the PA is not granted, Genentech Rheumatology Access Solutions can work with you to determine your next steps. Tips like this can be found in Forms and Documents.
 

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.