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Authorization for Rituxan?


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#1 fragiledancer2

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Posted 17 April 2012 - 01:14 PM

Hi- My rheumatologist is recommending IV Rituxan if my 3 gram Cellcept is not working - I relapsed after 12 years. I wonder if anyone has been successful in getting their insurance to pay for this - and what data you have given them, as I just got notified my insurance will not pay. Somebody at the office does the authorizations, but I wonder if my sending in recent academic research articles on successful Rituxan trials might be of benefit.

#2 Joelf

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Posted 17 April 2012 - 01:43 PM

Hi Fragiledancer,

I'm afraid I can't advise you as to whether your insurance company will pay for your IV Rituxan treatment, as I'm in the UK and I've no experience of private medical cover. (I've always been treated by our National Health Service).

However, I have found you a couple of threads "Rituxan Paid for by Drug Company!" and "Mini Allo HCST. Wife now has scleroderma. Suggestions?" whereby some of our members are discussing the payment of Rituxan by their insurance company.

I do hope this will be helpful to you and you are able to get the authorisation that you require.

Kind regards,

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#3 Teatime

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Posted 17 April 2012 - 05:30 PM

Hi- My rheumatologist is recommending IV Rituxan if my 3 gram Cellcept is not working - I relapsed after 12 years. I wonder if anyone has been successful in getting their insurance to pay for this - and what data you have given them, as I just got notified my insurance will not pay. Somebody at the office does the authorizations, but I wonder if my sending in recent academic research articles on successful Rituxan trials might be of benefit.


I think it really depends on how the insurance company classifies it. They seem to have leeway in the classification (or tiers) of drugs and treatments. Before Cellcept became available as a generic, I had my copays change based on the tier of drugs my insurer used to classify it. All of them have required prior authorization for Cellcept.

But if your insurer classifies it as "experimental," then you'll have a really difficult time. Is Rituxan an approved treatment for sclero? I know people who have taken it for RA and the insurance co. has paid for it.

#4 Amanda Thorpe

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Posted 19 April 2012 - 02:12 PM

Hello Fragiledancer

I am so sorry that you have relapsed after 12 years, that must be very, very hard to deal with. As I am in the UK I can't help with your specific query, what I can tell you is that a dear friend had rituximab (rituxn) here in the UK and felt it helped her. Funnily enough she had to have the funding for it agreed by the local health authority, well I think it was the local health authority, I may have my orgs mixed up but I do know the cost had to be authorised.

Take care.
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