Effective Oct. 1, UnitedHealthcare (UHC) updated its rituximab policy to require that patients fail to respond to both rituximab biosimilars, rituximab-pvvr (Ruxience) and rituximab-abbs (Truxima), prior to receiving approval for the originator rituximab (Rituxan). Current patients may continue receiving rituximab (Rituxan) after Oct. 1 for the duration of their existing prior authorization. However, once the authorization expires, patients will be required to switch to one of the biosimilar products.
The ACR reached out to UHC to express concern about non-medical switching between products that have not been ruled interchangeable by the U.S. Food & Drug Administration (FDA). In addition, we shared our concern that rituximab-pvvr (Ruxience) has not received FDA approval for rheumatoid arthritis (RA). The ACR objects to any policy requiring rheumatologists to prescribe a drug that has not received FDA approval for the indication in question. In response, UHC has given its assurance that patients with RA would not be forced to use rituximab-pvvr (Ruxience). When completing a prior authorization for rituximab (Rituxan), practices should note lack of FDA approval in lieu of documenting failure of rituximab-pvvr (Ruxience).
Contact ACR staff at [email protected] to report any problems with the prior authorization process or with questions regarding this policy or other insurance coverage concerns.