Rituxan and Medicare
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December 2, 2021 at 9:34 am
I was diagnosed with CIDP nine years ago. I have been on varying doses of Prednisone, IVIG, and now Hizentra since then. Because of my continued decline, my neurologist prescribed Rituxan and my private insurance finally agreed to cover the cost. But now as I approach retirement and switching to Medicare, I am wondering if anyone has any experience with getting Rituxan covered by Medicare?
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December 2, 2021 at 3:23 pm
Medicare covers Rituximab costs under Part B for certain conditions. Following is the latest summary:
https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdId=35026&ver=69
Depending on which Medicare Advantage plan you have, coverage will vary. Here is the Blue Shield California coverage statement:
Billing and Coding is crucial in getting Medicare coverage:
https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=56380&ver=43
I had my Rituximab treatment covered under Medicare. My experience with the treatments can be found here:
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December 22, 2021 at 11:40 am
Jim-LA,
Thanks for your reply. I read your description of your medical history. Could you clarify if Rituxan was approved for your CIDP or for the other medical issues you were dealing with? I am concerned that Medicare will deny coverage because it is not FDA approved to treat CIDP. Fortunately, we fought that battle with my employer provided health insurance and won because we were able to provide supporting evidence from research that showed its efficacy for CIDP.
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December 22, 2021 at 9:16 pm
It seems you are reluctant to share your Medicare health plan type here and that limits researching further recommendations. Did you read the CMS link about ‘Accepted Off-label Uses’? Since you already have experience getting off-label use approved for CIDP, you may need to leverage that experience again.
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