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Rituximab (Rituxan®)

Find drug coverage information and forms for rituximab, by funding source. Includes these indications:

  • GPA (granulomatosis with polyangiitis)
  • MPA (microscopic polyangiitis)
  • Nephrotic syndrome

Rituximab for GPA or MPA

What type of drug coverage does the patient have?

Private Insurance

  • Provide rituximab DIN 02241927 to patient to explore coverage through private insurer and if any special authorization forms are required.
  • Enrol in Jointeffort® program for coverage and infusion assistance. (See sidebar for enrolment form.)

Ontario Drug Benefit (ODB) and OHIP+

  • Rituximab will be considered for coverage through the exceptional access program (EAP) for the induction of remission of severely active Granulomatosis with Polyangiitis (GPA) OR microscopic polyangiitis (MPA) as combination treatment with glucocorticoids. Maintenance rituximab infusions will not be considered for coverage through EAP. (Eligibility Criteria)
  • Complete Exceptional Access Program (EAP) rituximab for GPA or MPA form. (See sidebar for form.)
  • Enrol in Jointeffort program for coverage and infusion assistance. (See sidebar for enrolment form.)

Trillium Drug Program (TDP)

  • Enrol into TDP if not already enrolled.
  • Complete Exceptional Access Program (EAP) rituximab for GPA or MPA form. (See sidebar for form.)
  • Enrol in Jointeffort program for coverage and infusion assistance. (See sidebar for enrolment form.)

Federal Non-Insured Health Benefits (NIHB) Program

Rituximab is covered as a Limited Use benefit for granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA), and prior approval is required. Have community pharmacy contact Drug Exception Centre for Limited Use Drugs Request Form to be sent to prescriber’s office. Send completed form to Drug Exception Centre.

Criteria for coverage:

  • For the treatment of granulomatosis with polyangiitis or microscopic polyangiitis, coverage is provided at a dose of 375 mg/m2 body surface area, administered as an IV infusion once weekly for 4 weeks.

    For the induction of remission in patients with severely active granulomatosis with polyangiitis or microscopic polyangiitis; AND
    • Who have failed an adequate trial of cyclophosphamide; OR
    • Who have a contraindication to cyclophosphamide.

To request rituximab for nephrotic syndrome, have community pharmacy contact Drug Exception Centre for Exception Drugs Request Form to be sent to prescriber’s office. Send completed form to Drug Exception Centre.

Interim Federal Health Program (IFHP)

  • Medication coverage and duration of coverage varies depending on each individual’s situation.
  • Contact IFHP with DIN 02241927 for assessment of coverage.
  • Enrol in Jointeffort program for coverage and infusion assistance. (See sidebar for enrolment form.)

No Medication Coverage

  • Option to pay cash for medication or enrol into TDP.
  • If enrolling in TDP, see TDP.

Rituximab for Nephrotic Syndrome

What type of drug coverage does the patient have?

Private Insurance

  • Provide rituximab DIN 02241927 to patient to explore coverage through private insurer and if any special authorization forms are required.
  • Consider applying to CRP and TDP at the same time of inquiry to private insurance in case of rejection of coverage from private insurer. TDP will require denial of coverage from private insurer(s) before providing coverage.

Ontario Drug Benefit (ODB) and OHIP+

  • Complete Compassionate Review Policy (CRP) form. (See sidebar for form.)
  •  If available, include additional information with request:
    • Medical note/letter
    • Biopsy report
    • Laboratory results including serial urine protein/ACR & SCr
    • Supporting references

Trillium Drug Program (TDP)

  • Enrol into TDP if not already enrolled.
  • Complete Compassionate Review Policy (CRP) form. (See sidebar for form.) If available, include additional information with request:
    • Medical note/letter
    • Biopsy report
    • Laboratory results including serial urine protein/ACR & SCr
    • Supporting references

Federal Non-Insured Health Benefits (NIHB) Program

Rituximab is covered as a Limited Use benefit for granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA), and prior approval is required. Have community pharmacy contact Drug Exception Centre for Limited Use Drugs Request Form to be sent to prescriber’s office. Send completed form to Drug Exception Centre.

Criteria for coverage:

  • For the treatment of granulomatosis with polyangiitis or microscopic polyangiitis, coverage is provided at a dose of 375 mg/m2 body surface area, administered as an IV infusion once weekly for 4 weeks.

    For the induction of remission in patients with severely active granulomatosis with polyangiitis or microscopic polyangiitis; AND
    • Who have failed an adequate trial of cyclophosphamide; OR
    • Who have a contraindication to cyclophosphamide.

To request rituximab for nephrotic syndrome, have community pharmacy contact Drug Exception Centre for Exception Drugs Request Form to be sent to prescriber’s office. Send completed form to Drug Exception Centre.

Interim Federal Health Program (IFHP)

  • Medication coverage and duration of coverage varies depending on each individual’s situation.
  • Contact IFHP with DIN 02241927 for assessment of coverage.

No Medication Coverage

  • Option to pay cash for medication, enrol in Jointeffort Program or enrol into TDP.
  • If enrolling in TDP, see TDP.

Disclaimer: The information contained herein (“Information”) is intended for informational purposes only, and no warranty as to its accuracy is provided or implied. The Information was collected from third party sources and is subject to change without notice. Cancer Care Ontario (CCO) makes no warranty that the Information is current. The Information is intended for use by healthcare professionals, subject to their clinical and/or professional judgment, to advise patients of drug funding options that may be available to them. Do not act or rely upon the Information without exercising your independent judgment or seeking the advice of a qualified professional. Anyone using the Information does so at his or her own risk. The drug funding options described herein are managed and funded by third parties, not by CCO. Please direct any inquiries to the applicable agency/entity who manages the drug funding option. CCO does not recommend or endorse the use of any drug or treatment method described herein.