Rituxan Medicare Coverage

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.

How much does Rituxan cost with Medicare?

If Medicare Part B covers Rituxan treatments for you because you meet the qualifying conditions, you’ll typically pay 0% to 20% of the Medicare-approved amount for the Rituxan prescription price, after you meet your Part B deductible.

In 2024, the Medicare Part B deductible is $240 per year. Once you pay this amount, you’ll pay the remaining copay costs Medicare Part B doesn’t cover.

Does Medicare cover Rituxan?

Medicare Part B covers injectable and infused drugs administered by a medical provider for qualified beneficiaries.

You don’t need a Medicare Advantage plan or a Medicare Part D prescription drug plan to get Rituxan coverage.¹

If you have either type of private drug plan, you’re enrolled in Medicare Part B, and you qualify for Medicare coverage of Rituxan, your Part B benefits will cover Rituxan.

Some Medicare Advantage plans and Medicare Part D plans cover other prescription drugs that aren’t administered in a doctor’s office or by a medical professional.

• Part D plans or Medicare Advantage plans that cover drugs include copay amounts that can range widely from one plan to another. Plan members may also be responsible for meeting a deductible before the plan’s drug coverage kicks in.
  
  
• Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). 89% of 2024 Medicare Advantage plans include prescription drug coverage.²
  
  
• Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover prescription drugs. We represent carriers such as Humana, UnitedHealthcare^®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

You can also compare Part D prescription drug plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

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.