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Rituximab

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

  • GPA (granulomatosis with polyangiitis)
  • MPA (microscopic polyangiitis)
  • Nephrotic syndrome related to GN conditions (e.g., membranous nephropathy)

Pharmaceutical manufacturers offer patient support programs for each of the rituximab medications approved in Canada. These programs offer a range of services including financial assistance, infusion support, and drug access navigation.

Rituximab for GPA or MPA

What type of drug coverage does the patient have?

Private Insurance

  • Patients with private insurance may be able to obtain full or partial coverage depending on their plan.
  • Provide patients with the names of the rituximab products so they can explore coverage through their private insurer. For a list of rituximab products, see our Open list of Drug Identification Numbers.
  • Assist patients with completing any special authorization forms (if required).
  • Enrol the patient in a patient support program if additional assistance is needed (e.g., infusion support, drug access navigation, financial assistance) (See sidebar for enrolment forms.) Options include:
    • Rituxan -Jointeffort Program (infusion support only)
    • Riximyo -XPOSE Program
    • Ruxience- Pfizer Liaison Program
    • Truxima -Teva Patient Support Solutions® Program

Ontario Drug Benefit (ODB) and OHIP+

  • Check that the patient qualifies for ODB benefits. If needed, enrol the patient in the Trillium Drug Program.
  • Riximyo, Ruxience, and Truxima are covered by ODB as a Limited Use (LU) benefit for induction or maintenance of remission of granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) in patients that meet specified criteria. LU codes and clinical criteria are available on the ODB e-Formulary. Click below for details:

Include the LU code on the prescription or under “Directions” or “Prescription” sections on the enrolment forms for patient support programs offered by drug manufacturers.

  • Effective July 31, 2020, the Exceptional Access Program (EAP) no longer funds Rituxan for patients with GPA and MPA. Enrol the patient in a patient support program, if additional assistance is needed (e.g., infusion support, drug access navigation, financial assistance). (See sidebar for enrolment forms.)

Options include:

  • Riximyo -XPOSE Program
  • Ruxience- Pfizer Liaison Program
  • Truxima -Teva Patient Support Solutions® Program

Trillium Drug Program (TDP)

  • The Trillium Drug Program (TDP) helps patients pay for prescription drugs covered under the Ontario Drug Benefit formulary, Exceptional Access Program, and Compassionate Review Policy.
  • Patients who do not qualify under other categories for ODB benefits, should enrol into TDP (if not already enrolled).
  • Use LU codes under LU benefit (see ODB and OHIP+).
  • Enrol the patient in a patient support program if additional assistance is needed (e.g., infusion support, drug access navigation, financial assistance) (See sidebar for enrolment forms.) Options include:
    • Riximyo- XPOSE Program
    • Ruxience- Pfizer Liaison Program
    • Truxima -Teva Patient Support Solutions Program

Non-Insured Health Benefits (NIHB) Program

The Non-Insured Health Benefits (NIHB) program is a federal program that provides eligible First Nations and Inuit clients with coverage for a range of health services including prescription drugs.

Rituximab is covered as a Limited Use benefit for granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA), and prior approval is required. To apply, a community pharmacy can contact NIHB’s Drug Exception Centre who can send a Limited Use Drugs Request Form to the prescriber. Send the completed form back to Drug Exception Centre.

For more information on NIHB and the prior approval process, see NIHB’s Guide for Pharmacy Benefits.

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.

For the most up-to-date eligibility criteria, please consult NIHB’s Drug Benefit List

Interim Federal Health Program (IFHP)

  • The Interim Federal Health Program (IFHP) provides temporary coverage of healthcare benefits including prescription drug coverage to refugees, refugee claimants and certain other groups who are not eligible for provincial or territorial health insurance (e.g., OHIP).
  • The IFHP provides coverage for prescription medications for medications listed on provincial/territorial public drug plans. In Ontario, the IFHP pays for medications listed on Ontario Drug Benefit formulary.
  • Health care providers who would like to work with patients covered by IFHP (e.g., pharmacists checking drug coverage eligibility) must register to be an IFHP provider (See IFHP information for professionals).
  • If you need a product name and/or drug identification number for rituximab, see our Open list of Drug Identification Numbers.

For more information on current eligibility criteria and application processes, please visit IFHP’s website.

  • Enrol the patient in a patient support program, if additional assistance is needed (e.g., infusion support, drug access navigation, financial assistance). (See sidebar for enrolment forms.) Options include:
    • Rituxan -Jointeffort Program (infusion support only)
    • Riximyo -XPOSE Program
    • Ruxience- Pfizer Liaison Program
    • Truxima -Teva Patient Support Solutions Program

No Medication Coverage

  • Option to pay cash for medication or the patient can enrol in the Trillium Drug Program (TDP) to qualify for benefits under the Ontario Drug Benefit program.

Rituximab for Nephrotic Syndrome

What type of drug coverage does the patient have?

Private Insurance

  • Patients with private insurance may be able to get full or partial coverage depending on their plan.
  • Provide patients with the names of the rituximab products so they explore coverage through private insurer. For a list of rituximab products, see our Open list of Drug Identification Numbers.
  • Assist patients with completing any special authorization forms (if required).
  • In case the private insurer will not approve funding, consider applying to the ministry’s Exceptional Access Program and Trillium Drug Program (TDP) at the same time the patient applies to private insurance. TDP will require denial of coverage from private insurer(s) before providing coverage.

Ontario Drug Benefit (ODB) and OHIP+

  • Confirm that your patient qualifies for ODB benefits. If not, enrol the patient in the Trillium Drug Program.
  • Rituximab for nephrotic syndrome is not an ODB formulary benefit. Effective July 29, 2022, prescribers can apply to the Exceptional Access Program.
  • 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)

  • The Trillium Drug Program (TDP) helps patients pay for prescription drugs covered under the Ontario Drug Benefit formulary, Exceptional Access Program, and Compassionate Review Policy.
  • Patients who do not qualify under other categories for ODB benefits, should enrol into TDP if not already enrolled.
  • Complete the 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

Non-Insured Health Benefits (NIHB) Program

The Non-Insured Health Benefits (NIHB) program is a federal program that provides eligible First Nations and Inuit clients with coverage for a range of health services including prescription drugs.

Rituximab for the treatment of GN-related nephrotic syndrome is not a formulary benefit. Prescribers must submit a prior approval for funding consideration. A community pharmacy can contact NIHB’s Drug Exception Centre who can send the Exception Drugs Request Form to a prescriber’s office. Send the completed form to Drug Exception Centre.

For more information on NIHB and the prior approval process, see NIHB’s Guide for Pharmacy Benefits.

Interim Federal Health Program (IFHP)

  • The Interim Federal Health Program (IFHP) provides temporary coverage of healthcare benefits including prescription drug coverage to refugees, refugee claimants and certain other groups who are not eligible for provincial or territorial health insurance (e.g., OHIP).
  • The IFHP provides coverage for prescription medications for medications listed on provincial/territorial public drug plans. In Ontario, the IFHP pays for medications listed on Ontario Drug Benefit formulary.
  • Health care providers who would like to work with patients covered by IFHP (e.g., pharmacists checking drug coverage eligibility) must register to be an IFHP provider (See IFHP information for professionals).
  • If you need a product name and/or drug identification number for rituximab, see our Open list of Drug Identification Numbers. For more information on current eligibility criteria and application processes, please visit IFHP’s website.

No Medication Coverage

  • Option to pay cash for medication, enrol in manufacturer patient support programs or the patient can enrol into Trillium Drug Program (TDP) to quality for benefits under the Ontario Drug Benefit program.
  • If enrolling in manufacturer patient support programs, see sidebar for enrolment forms. Options include:
    • Rituxan -Jointeffort Program (infusion support only)
    • Riximyo -XPOSE Program
    • Ruxience- Pfizer Liaison Program
    • Truxima - Teva Patient Support Solutions Program
  • If enrolling in TDP, see the above section on the Trillium Drug Program.

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. Ontario Health (Ontario Renal Network) makes no warranty that the Information is current. The Information is intended for use by healthcare professionals 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 on this website are managed and funded by third parties, not by Ontario Health (Ontario Renal Network). Please direct any inquiries to the applicable agency/entity who manages the drug funding option.