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Rituximab (CPB 0314, reviewed 2026-09-15)
Effective date
Not stated in the notice
Identified
Oct 3, 2026
Summary
Aetna Clinical Policy Bulletin 0314 sets coverage criteria for rituximab (Rituxan), rituximab-abbs (Truxima), rituximab-arrx (Riabni), rituximab-pvvr (Ruxience) and rituximab and hyaluronidase human (Rituxan Hycela) under commercial medical plans. Precertification is required for these products in applicable plan designs. Rituximab is covered for the listed hematologic and oncologic conditions and for the listed rheumatoid arthritis and other conditions when the stated criteria are met, and all other indications are considered experimental, investigational, or unproven.
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What to do
Action · 9 steps
01Precertification is required of Aetna participating providers and members for these rituximab products in applicable plan designs.
02Call (866) 752-7021 or fax (888) 267-3277.
03Statement of Medical Necessity precertification forms are on the Specialty Pharmacy Precertification page.
04Site of Care Utilization Management Policy applies to Rituxan, Truxima, Riabni and Ruxience, and site of service information is in the Utilization Management Policy on Site of Care for Specialty Drug Infusions.
05The medication must be prescribed by or in consultation with the specialists the policy lists for each condition, such as rheumatologists or immunologists for rheumatoid arthritis and lupus.
06For rheumatoid arthritis, the member must have a positive rheumatoid factor or anti-CCP test, or testing for rheumatoid factor, anti-CCP, and CRP and/or ESR, and the medication must be prescribed with methotrexate or leflunomide unless the member has a clinical reason not to use them.
07Members will not receive these products with another biologic or targeted synthetic drug for RA, with other disease-modifying MS agents, or concomitantly with other biologics for neuromyelitis optica.
08Approvals may be subject to dosing limits under the Medical Specialty Medication Quantity Limits.
09CPT codes 62350, 62351, 83520 and 96450 are not covered for the indications listed in the CPB.
Codes mentioned
62350623518352096450J9311J9312Q5115Q5119Q5123D47.Z1D47.Z2D69.3D89.811G36.0G70.00G70.01G93.49H55.89I77.82L10.0L10.2L10.81L12.0L12.1M31.7N04.0
Original notice
Rituximab (CPB 0314, reviewed 2026-09-15)
aetna.com · Always check the source before changing claims.
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Related policy hubs
Aetna policiesRheumatologyOncologyHematologyNeurologyNephrologyOphthalmologyDermatologyPulmonologyTransplant SurgeryPediatricsCode 62350Code 62351Code 83520Code 96450Code J9311Code J9312Code Q5115Code Q5119Code Q5123Code D47.Z1Code D47.Z2Code D69.3Code D89.811Code G36.0Code G70.00Code G70.01Code G93.49Code H55.89Code I77.82Code L10.0Code L10.2Code L10.81Code L12.0Code L12.1Code M31.7Code N04.0