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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

April 2017

Updated Medical Review Criteria for Rituxan


Effective for services authorized on or after April 1, 2017, Harvard Pilgrim is updating its medical review criteria for Rituxan. Harvard Pilgrim covers the medically necessary use of Rituxan to treat certain conditions in patients 18 and older.

Effective immediately, coverage for the medication will be expanded to include the following indications:

  • Acquired Blood Factor Deficiency
  • Castleman’s Disease
  • Sjögren’s Syndrome

As a reminder, all use of Rituxan, which is administered by intravenous infusion, requires prior authorization. It must be supported by evidence-based literature, and clinically appropriate based on the member’s condition and previous response to treatment. For more information and the complete list of covered conditions, please refer to Harvard Pilgrim’s updated Rituxan Medical Review Criteria.

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