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.
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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.