Reply To: How did you get your insurance to cover Rituxan?

April 27, 2019 at 11:43 pm

Anthem Blue Cross and their subsidiaries have varying drug approval policies by State.

It seems State policies can be interpreted differently by different BCBS reviewers too. I had a denial from ABC of California (power wheelchair configurations) that I had to appeal to the DOI and file an official grievance. It took 3-4 months and ABC was instructed to change their ruling in my case. Your State DOI may offer a similar option.

It appears BCBS has approved Rituximab for other forum members in the past. Please read the following thread started by JoMama:

help getting BCBS approvial for Rituxan treatment of CIDP

Have you read your State’s BCBS policy regarding the use of Rituximab? Does it say anything about
patients with Immunoglobulin G4 (IgG4) Autoantibodies? Does it give you any info that could be used in an appeal through your DOI?

I was able to get approval for Rituximab from Medicare Part B when given as an outpatient procedure at a medical facility (a division of a center of excellence in my area). In my case, some B-lymphocytes were found to exhibit the antigen CD20 which was the medical necessity info Medicare needed to approve Rituximab treatments. It has put my CIDP/MFS in remission, maybe stopped it altogether (time will tell).

Best of luck to all who must fight the penny-pinching insurance Co’s!