Rituxan® Medicare Coverage

Rituxan®
Chemical name: Rituximab

Typical dosage: 10mg/ml

Typical type: Injection1

Rituxan® is a medication typically used to treat chronic lymphocytic leukemia, granulomatosis, microscopic polyangiitis, non-Hodgkin lymphomas, pemphigus vulgaris and rheumatoid arthritis. Rituxan is brand only and is available as an intravenous injection.

Rituxan is administrated as an IV infusion over a period of time by a licensed healthcare provider in a healthcare facility. You cannot fill a prescription for Rituxan at a retail pharmacy.

Rituxan contains the active ingredient Rituximab. Rituxan dosing regimens vary depending on the condition being treated.

Rituxan targets CD20 antigens on normal and cancerous B-cells. This activates the body’s natural immune defenses to attack and kill the marked B-cells.

The major side effects associated with Rituxan include nausea and vomiting, fatigue, weakness, headache, stomach pain, muscle spasms and pain, cold symptoms (runny or stuffy nose, throat irritation) and diarrhea.

Does Medicare cover Rituxan?

Medicare Part B may cover Rituxan if your doctor deems it medically necessary to treat your specific condition.

If you have a Medicare Advantage plan, your plan will cover qualified Rituxan treatment that would be covered by Medicare Part B.

Many Medicare Advantage plans also include coverage for other prescription drugs that may not be covered by Original Medicare.

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Average costs for Rituxan with Medicare drug coverage1

Medicare coverage for Rituxan can vary. You should speak with your doctor and contact your Medicare plan carrier to learn more about how your Rituxan treatment may be covered by your plan.

If your Rituxan treatment is covered by Medicare Part B, you will typically be responsible for paying the Part B coinsurance or copayment (20 percent of the Medicare approved amount) after you meet the Part B deductible, which is $185 per year in 2019.

Additional information

Other drugs will probably be given in combination with Rituxan to help avoid major side effects.

While many patients can safely take Rituxan, it is not recommended for pregnant women due to fetal risk, and breastfeeding should be avoided for 6 months after the last dose.

Hepatitis B virus reactivation may occur while taking Rituxan and can lead to worsening hepatitis, liver failure or death. If Hepatitis B is reactivated during Rituxan therapy, the medication should be stopped.

A severe skin reaction (Stevens-Johnson syndrome, toxic epidermal necrolysis) may occur while taking Rituxan. Get medical help right away if you have signs like red, swollen, blistered or peeling skin (with or without fever), red or irritated eyes, or sores in your mouth, throat, nose or eyes.

A severe brain problem called progressive multifocal leukoencephalopathy (PML) has occurred with Rituxan. Tell your doctor right away if you have signs like confusion, memory problems, low mood, a change in the way you act, change in strength on one side is greater than the other, trouble speaking or thinking, change in balance or change in eyesight.

 

 

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

 

Written by Hayden Gharibyar, Pharm.D.

Copyright © 2019 TZ Insurance Solutions LLC. All rights reserved.

1 GoodRx. Rituxan. Retrieved May 2019, from www.goodrx.com/rituxan.

2 Jacobson, Gretchen; et al. A Dozen Facts About Medicare Advantage. (Nov. 13, 2018). Kaiser Family Foundation. Retrieved from www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage.

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